Relationship between endoscopic esophagitis and patterns of gastroesophageal reflux in ambulatory pHmetry

AIM: to evaluate the possible relationship between the various grades of en doscopic esophagitis and the different patterns of reflux determined by 24- hour ambulatory pH-metry. PATIENTS AND METHODS: We selected 80 patients with symptoms of gastroesopha geal reflux disease in whom upper digestive tract endoscopy revealed some d egree of mucosal lesion. These patients subsequently underwent 24-hour ambu latory pHmetry. The lesions of the mucosa were classified into 4 grades acc ording to the criteria of Savary and Miller The patterns of reflux were det ermined by 24-hour pHmetry and classified according to the severity of refl ux (slight, moderate or severe, using DeMeester's table) and the type of re flux tin bipedestation, supine or mixed) according to the percentage of tim e at pH < 4 in bipedestation, in decubitus or in both positions. RESULTS: patients with grades I and II esophagitis showed variable patterns of reflux, although the most frequent seemed to be slight in bipedestation , which we observed in 34% of the patients. Most (76.2%) of the patients wi th grades III or IV (p < 0.05) showed a clearly defined pattern of severe t ype in the supine position or in both positions. CONCLUSIONS: the presence of a reflux pattern of predominantly supine or mi xed type in 24-hour pHmetry may help to identify patients at higher risk fo r developing severe esophagitis or other complications.