Postprandial Acid Exposure Research Articles

Alginate antacid (Gaviscon DA) chewable tablets reduce esophageal acid exposure in Chinese patients with gastroesophageal reflux disease and heartburn symptoms.

To assess the efficacy of Gaviscon Double Action (DA) alginate antacid chewable tablets for reducing esophageal acid exposure in Chinese patients with gastroesophageal reflux disease (GERD). Altogether 44 patients reporting moderate to severe heartburn symptoms underwent two pH monitoring visits. The treatment sequence was randomized to patients received DA alginate antacid or placebo at one visit and the alternate treatment 7 days later. After a standardized reflux-provoking meal, patients took four tablets of DA alginate antacid or placebo. Esophageal pH was measured for 4 h post-dosing using an electrode positioned 5 cm above the lower esophageal sphincter. The primary end-point was the percentage of 4-h post-dosing period with pH <4. Secondary end-points were number of acid reflux episodes (pH <4), longest reflux time and DeMeester scores. All 44 patients completed the study and provided data for analysis. With DA alginate antacid, the mean percentage time with pH <4 was 5.1%, significantly less (P = 0.0003) than with placebo (14.8%). DA alginate antacid was statistically significantly superior (P = 0.0290) to placebo (from at least twofold to threefold better) for all other end-points. Two patients reported two mild adverse events (AEs) that resolved within a month of completing the study. No patients had serious and/or severe AEs and none withdrew due to AEs. DA alginate antacid was statistically significantly superior to placebo in reducing post-prandial acid exposure without serious clinically relevant health risks. These findings suggest DA alginate antacid tablets are appropriate for treating acid reflux in Chinese GERD patients with heartburn symptoms.

The postprandial acid pocket does not extend into most distal esophagus: evidence from pH studies performed immediately above the squamocolumnar junction

Objective. The postprandial acid pocket is suggested to be an important factor in the pathogenesis of gastroesophageal reflux disease (GERD) as it according to the theory extends into the distal esophagus. The aim of this study was to test the hypothesis that the acid pocket transverses the squamocolumnar junction (SCJ) and exposes the most distal esophagus to gastric acid for extended periods following a meal. Material and methods. Fifty asymptomatic volunteers and 75 patients with GERD underwent 48-h pH monitoring with the electrode of a pH capsule placed immediately above the SCJ. The characteristics of esophageal acid exposure from the 90-min postprandial periods were compared with those observed during the upright, preprandial periods. Results. In asymptomatic controls, the degree of postprandial esophageal acid exposure was similar to that observed in the preprandial periods (median % time with pH <4, 2.2 vs. 2.6, p = 0.165). In contrast, symptomatic patients had significantly greater acid exposure in the postprandial compared with the preprandial periods (median % time with pH <4, 15.5 vs. 8.5, p < 0.001). The higher degree of acid exposure during the postprandial periods was due to a significantly higher number of short reflux episodes and reflux events with long durations were infrequent. Conclusion. Postprandial acid exposure in the most distal esophagus was characterized by numerous short reflux events, and reflux events of long durations were rare. Our observations suggest that the acid pocket is confined to the stomach, questioning the importance of the acid pocket in GERD.

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Effect of azithromycin on acid reflux, hiatus hernia and proximal acid pocket in the postprandial period

BackgroundThe risk for acidic reflux is mainly determined by the position of the gastric acid pocket. It was hypothesised that compounds affecting proximal stomach tone might reduce gastro-oesophageal reflux by...

P.20 CLINICAL AND MANOMETRIC EFFECT OF ENDOSCOPIC ESOPHAGEAL INJECTION OF BOTULIN TOXIN IN DIFFUSE ESOPHAGEAL SPASM IN ELDERLY PATIENTS

in both symptomatic and asymptomatic twins, but there was no differences between the groups in pre or post-prandial acid reflux episode frequency or total post-prandial acid exposure (symptomatic twins median 11 (range 0-1051)s, asymptomatic twins 4(0-487)s (p=0.4). Moreover preprandial LOS pressure of 13 (4-29) mmHg fell to 8 (2-13)after the meal (p= 0.0001). No difference was found in basal and post prandial lower esophageal sphincter pressure readings between asymptomatic and symptomatic twins (p=0.2). Conclusions: There was no difference in pre and post prandial TLOSR and in LOS pressure in twins discordant for GORD symptoms. # A. Oesophagus 1. GERD

Gastric emptying: a contributory factor in gastro-oesophageal reflux activity?

AIMSTo evaluate the impact of total and proximal stomach emptying on 24 hour and postprandial reflux as well as the number of reflux episodes per hour in relation to the...

Exclusion of meal periods from ambulatory 24-hour pH monitoring May improve diagnosis of esophageal acid reflux

Distal esophageal pH less than 4 is frequently seen during meal ingestion in 24-hr ambulatory pH monitoring for the diagnosis of gastroesophageal reflux disease (GERD). The characteristics of this meal-related apparent reflux without diet restriction was evaluated. Data from normal volunteers (N = 21) and consecutive patients (N = 66) referred with heartburn and/or chest pain were studied with ambulatory pH monitoring. The median percent times pH < 4 in the distal esophagus were significantly greater in symptomatic patients than controls for total 24-hr, upright, and supine periods, and postprandial periods of 30, 60, 90, 120, and 150 min (P values of 0.007-0.03). However, the median percent time pH < 4 during the meal periods was the same for patients (4.4%) and for controls (6.6%) with P = 0.23. Excluding the meal periods from analysis resulted in greater separation between controls and patients with abnormal acid exposure when compared to the conventional method. Patients should maintain their usual routine without diet restriction during 24-hr ambulatory pH studies in the clinical setting. Furthermore, exclusion of meal periods can eliminate meal-time pH variabilities without affecting postprandial acid exposure and improve the diagnosis of GERD.