REFLUX RELATED SYMPTOMS IN PATIENTS WITH NORMAL ESOPHAGEAL EXPOSURE TO ACID

Several studies, using pH monitoring with event markers, have identifi ed patients with normal oesophageal exposure to acid despite an appare nt relation between symptoms and reflux episodes. In this series of 77 1 consecutive patients referred for 24 hour oesophageal pH monitoring, a probability calculation was used to evaluate the relation between s ymptoms and reflux episodes. Oesophageal exposure to acid was normal i n 462 of 771 recordings (59.9%); despite this, 70.8% (327 of 462) of t hese patients used at least once the event marker. In 96 patients (12. 5% of total patients) with normal oesophageal exposure to acid, there was a statistically significant association between symptoms and reflu x episodes. The symptom cluster of such patients was similar to that u sually seen in patients with gastro-oesophageal reflux disease, but sy mptoms like belching, bloating, and nausea were common thus overlappin g with the symptom pattern of functional dyspepsia. In these patients both the duration and the minimum pH of reflux episodes (either sympto m related or asymptomatic) were significantly shorter and higher, resp ectively, when compared with those of patients with gastrooesophageal reflux disease. These results are consistent with the idea that oesoph ageal hypersensitivity to acid is the underlying pathophysiological fe ature of this syndrome.