Haylet, K.R.; Vales, P.; Lee, S.H.; McCloy, R.F.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA23
Academic Journal
Background and Aims: Although considered the "gold standard" for assessing gastro-oesophageal acid reflux, evidence suggests a poor correlation between pH measurements and the degree of oesophagitis seen during endoscopy. The current pH features examined, described as exposure, focus on the time the measured pH falls below 4. Importantly, these measures do not take into account distension of the oesophageal lumen. This study examined the diameter of the oesophageal lumen, its effect on mucosal folds and the effect that these may have on acid exposure at the mucosa. Methods: The diameters of the oesophageal lumen of 25 patients under investigation for oesophageal disorders were studied using a video barium swallow. The widest luminal diameter was measured for each subject for a series of five controlled swallows and the results critically examined with regard to the usual measure of acid exposure. Results: The results showed the lumen diameter varies widely from 0.9 to 3.8 cm. No difference in maximum luminal diameter was found beh, veen successful and failed swallows (student t, p > 0.05). In addition, results from endoscopy show oesophagitis often occur at the tips of the mucosal folds creating linear longitudinal patterns of erthyma. Changes in lumen diameters have also been previously shown to affect the different degrees of mucosal folding. These results suggest that individual patients may have varying areas of mucosa exposed to luminal content. As a result of these considerations a new Acid Exposure Unit was developed to take into account not only the time of exposure but also pH and the area of mucosa exposed. Conclusion: In conclusion the range of luminal diameters measured and the developed exposure units highlight that the current measures of oesophageal pH exposure, which do not include the area of mucosa exposed, may explain why only a poor correlation is found between pH measurements and the degree of oesophagitis seen during endoscopy.


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