DUODENOGASTRIC AND NONACID GASTROESOPHAGEAL REFLUX IN PATIENTS WITH REFLUX ESOPHAGITIS

Background/Aims: The role and the identification criteria of non acid gastro-oesophageal reflux (GOR) are still debated. Moreover the relati onship between nonacid COR and gastric alkalinizations, particularly i f secondary to duodeno-gastric reflux is yet to be defined. Materials and Methods: One hundred and forty one patients affected by GORD sympt oms and oesophagitis entered the study. Oesophagitis was divided into four categories, according to a modified Savary and Miller classificat ion. Acid (pH<4), alkalacid (4<H<7), alkaline (pH>7) GOR and duodenoga stric reflux were measured by means of ambulatory three channel esopha go-gastric pH monitoring with a combined analysis of the pH traces rec orded in the oesophagus, fundus and antrum. Results: Total time percen tage (T%) of acid GOR was significantly greater in patients than in he althy volunteers (HV) and between groups of patients in direct relatio n with the severity of the oesophagitis. Alkaline GOR was hardly detec table in every class of esophagitis. Alkalacid GOR increased with the grade of severeness of oesophagitis. Alkalacid COR occurred prevalentl y in the postprandial period; it was only 8% of the time in patients w ith mild reflux oesophagitis and even less in patients with moderate o r severe oesophagitis. The 24 hr total time percentage of duodenogastr ic reflux was similar in the patients and healthy volunteer groups. Th e frequency distribution in 0.1 intervals of fundic and antral pH samp les showed a greater number of them in the acid range (0.8-1.2) in the patients than in healthy volunteer group (0.0006<p<0.05). The frequen cy distribution of alkalacid (4<pH<7) and alkaline (pH<7) samples was similar in patients and in healthy volunteers. Conclusions: Our findin gs demonstrate that alkaline COR is rare in GORD patients and that non acid GOR has a minor role in the pathophysiology of reflux esophagiti s.