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. 1995 Oct;37(4):465–470. doi: 10.1136/gut.37.4.465

Alkaline gastro-oesophageal reflux: dual probe pH monitoring.

S Y Iftikhar 1, S Ledingham 1, D F Evans 1, S W Yusuf 1, R J Steele 1, M Atkinson 1, J D Hardcastle 1
PMCID: PMC1382894  PMID: 7489929

Abstract

Although the aetiology of Barrett's oesophagus or columnar line oesophagus (CLO), remains unknown, bile reflux has been implicated as a factor in its pathogenesis. This study aimed to detect alkaline reflux in gastro-oesophageal reflux patients using dual probe pH monitoring. Thirty patients with histologically diagnosed CLO, 15 age and sex matched patients with oesophagitis (grade 1-3), and 15 healthy volunteers were studied by dual probe, 18 hour pH monitoring and analysis of the bile acid content of oesophageal refluxate. Total acid exposure and acid exposure in the upright and supine postures were greater in CLO subjects than in oesophagitis patients and controls. Furthermore, the number of reflux episodes lasting more than five minutes and the duration of the longest reflux episode were significantly greater in the CLO subjects than the oesophagitis and control subjects. Nine subjects with CLO and oesophagitis, however, were not identified as refluxers, although six had a bile acid concentration in their oesophageal aspirate higher than the 95th centile value of the controls. There was no correlation between the oesophageal pH and the bile acid contents of refluxate. It is concluded that dual probe pH monitoring is not useful in detecting alkaline refluxers. pH monitoring, although the only subjective test available to identify acid refluxers, is not a sufficiently sensitive test with which to define alkaline reflux.

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Selected References

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  1. Attwood S. E., Ball C. S., Barlow A. P., Jenkinson L., Norris T. L., Watson A. Role of intragastric and intraoesophageal alkalinisation in the genesis of complications in Barrett's columnar lined lower oesophagus. Gut. 1993 Jan;34(1):11–15. doi: 10.1136/gut.34.1.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Demeester T. R., Johnson L. F., Joseph G. J., Toscano M. S., Hall A. W., Skinner D. B. Patterns of gastroesophageal reflux in health and disease. Ann Surg. 1976 Oct;184(4):459–470. doi: 10.1097/00000658-197610000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dodds W. J. Instrumentation and methods for intraluminal esophageal manometry. Arch Intern Med. 1976 May;136(5):515–523. [PubMed] [Google Scholar]
  4. Gillen P., Keeling P., Byrne P. J., Healy M., O'Moore R. R., Hennessy T. P. Implication of duodenogastric reflux in the pathogenesis of Barrett's oesophagus. Br J Surg. 1988 Jun;75(6):540–543. doi: 10.1002/bjs.1800750612. [DOI] [PubMed] [Google Scholar]
  5. Gillen P., Keeling P., Byrne P. J., Hennessy T. P. Barrett's oesophagus: pH profile. Br J Surg. 1987 Sep;74(9):774–776. doi: 10.1002/bjs.1800740906. [DOI] [PubMed] [Google Scholar]
  6. Gotley D. C., Morgan A. P., Cooper M. J. Bile acid concentrations in the refluxate of patients with reflux oesophagitis. Br J Surg. 1988 Jun;75(6):587–590. doi: 10.1002/bjs.1800750632. [DOI] [PubMed] [Google Scholar]
  7. Iascone C., DeMeester T. R., Little A. G., Skinner D. B. Barrett's esophagus. Functional assessment, proposed pathogenesis, and surgical therapy. Arch Surg. 1983 May;118(5):543–549. doi: 10.1001/archsurg.1983.01390050027005. [DOI] [PubMed] [Google Scholar]
  8. Iftikhar S. Y., Ledingham S., Steele R. J., Evans D. F., Lendrum K., Atkinson M., Hardcastle J. D. Bile reflux in columnar-lined Barrett's oesophagus. Ann R Coll Surg Engl. 1993 Nov;75(6):411–416. [PMC free article] [PubMed] [Google Scholar]
  9. Meyer W., Vollmar F., Bär W. Barrett-esophagus following total gastrectomy. A contribution to it's pathogenesis. Endoscopy. 1979 May;11(2):121–126. doi: 10.1055/s-0028-1098335. [DOI] [PubMed] [Google Scholar]
  10. Moossa A. R., Skinner D. B. Gastro-oesophageal reflux and hiatal hernia. A re-evaluation of current data and dogma. Ann R Coll Surg Engl. 1976 Mar;58(2):126–132. [PMC free article] [PubMed] [Google Scholar]
  11. Ritchie W. P., Jr Bile acids, the "barrier," and reflux-related clinical disorders of the gastric mucosa. Surgery. 1977 Aug;82(2):192–200. [PubMed] [Google Scholar]
  12. Singh S., Bradley L. A., Richter J. E. Determinants of oesophageal 'alkaline' pH environment in controls and patients with gastro-oesophageal reflux disease. Gut. 1993 Mar;34(3):309–316. doi: 10.1136/gut.34.3.309. [DOI] [PMC free article] [PubMed] [Google Scholar]

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