Subcardial 24-h Wireless pH Monitoring in Gastroesophageal... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: ESOPHAGUS

Subcardial 24-h Wireless pH Monitoring in Gastroesophageal Reflux Disease Patients With and Without Hiatal Hernia Compared With Healthy Subjects

Grigolon, Ausilia MD1,2; Cantú, Paolo MD1,2; Bravi, Ivana MD1,2; Caparello, Chiara MD1,2; Penagini, Roberto MD1,2

1Cattedra di Gastroenterologia, Dipartimento di Scienze Mediche, Università degli Studi of Milan, Milan, Italy; 2Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.

Correspondence: Roberto Penagini, MD, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, Padiglione Granelli, Via F. Sforza n.35, Milano 20122, Italy. E-mail: [email protected]

Received 17 March 2009; accepted 29 June 2009

Abstract

OBJECTIVES:

After meals, highly acidic gastric juice is present in the subcardial region, the so-called acid pocket. Patients with gastroesophageal reflux disease (GERD) have a higher frequency of acidic reflux. Our aim was to investigate the possible differences in subcardial pH in GERD over 24 h and the role of hiatal hernia (HH), using a wireless capsule.

METHODS:

A total of 14 healthy volunteers (4 men, 24-60 years), 10 GERD patients without HH (4 men, 25-68 years), and 11 GERD patients with HH ≥3cm (2 men, 46-74 years) underwent 24-h wireless pH monitoring 2 cm below the squamocolumnar junction. All patients had increased 24-h acid reflux. A standardized lunch was given to all study subjects.

RESULTS:

No capsule detached during the 24-h recording. Median 24-h pH was similar in healthy subjects, and in patients without and with HH, median: 1.4 (interquartile range: 1.2-1.9), 1.5 (1.3-1.7), and 1.4 (1.3-1.7), respectively. Similar results were seen in the supine period. Median pH after the standardized meal was often highly acidic, 2.7 (1.5-3.2), 1.9 (1.6-2.3), and 2.5 (1.6-3.2), respectively. The first minute with a median pH <2 occurred 14min (4-49), 14min (6-25), and 20 min (4-43), respectively, P =NS, after the end of the meal. Similar data were observed on pooling all meals together.

CONCLUSIONS:

Subcardial pH is confirmed to be highly acidic early after meals, but it is similar over 24h in healthy subjects and GERD patients independent of the presence of HH.

Am J Gastroenterol 2009; 104:2714-2720; doi:10.1038/ajg.2009.443; published online 28 July 2009