W1838 Micro-Aspiration and Stability of Gastric Pepsin

Abstract

Background Typical symptoms of gastroesophageal reflux disease (GERD) are heartburn and regurgitation. Extraesophageal (EE) symptoms such as cough and throat clearing are less commonly associated with GERD but represent a common presenting symptom for reflux testing. Proximal extent of refluxate into the larynx or even the lungs is proposed as a potential mechanism for EE symptoms. Aim We tested the hypothesis that EE symptoms are more frequently associated with proximal esophageal reflux than typical symptoms. Methods A blinded assessment was rigorously applied. Themultichannel intraluminal impedance-pH (MII-pH) tracings analyzed for this study were edited by one of the investigators so that none of the symptom markers were visible and the reflux associated symptoms reviewed were simply marked as symptom 1-5 for each patient. 815 consecutive MII-pH reports were reviewed to identify 40 patients with at least 5 symptom events preceded by a reflux episode, thus a total of 50 reflux related events in each of 4 symptom groups: cough, throat clearing, heartburn, and regurgitation. A second investigator blindly analyzed all 200 episodes by reporting the extent of the refluxate at 7, 9, 15, and 17 cm above the LES. Results The percentage of symptom related reflux extending proximally to 17 cm above the LES is similar among all four symptom types (Figure 1). At least 50% of all symptoms were associated with proximal reflux to 17 cm above the LES, with the numerically highest being regurgitation (60%). There is no significant difference between any of the values. Conslusion This study confirms the frequent association of proximal reflux with GERDrelated symptoms previously identified. However, as opposed to common beliefs, our data indicate that EE GERD-related symptoms are not more frequently associated with proximal reflux than typical GERD symptoms. Both EE and esophageal symptoms are associated with reflux to 17cm at least 50% of the time.