Characterization of Gastroesophageal Reflux (pp. 259-266)
Authors: (Valter Nilton Felix, São Paulo University and Nucleus of General and Specialized Surgery, São Paulo, Brazil)
Abstract: Introduction: A correct GERD diagnosis depends on clinical, radiological, endoscopic and functional data. The aim of the chapter is to verify how the measurement of bile reflux can increase the diagnostic accuracy of GERD.
Methodology: 15 Barrett's patients and 15 GERD patients (endoscopic erosive esophagitis) were fasted for 6 h before any examinations and the patients ceased acid suppression medications 72 h earlier. Ten healthy volunteers adhered to a standard protocol. LES was localized manometrically and then a Bilitec 2000 fiberoptic probe (Synectics, Medtronics) and an antimony pH probe attached to a Digitrapper Mark III pH recorder (Synectics, Medtronics), together, were inserted through the nostril and positioned 5cm above the LES. The individuals received an uncolored diet and after around 24 h, both Bilitec and pH data were downloaded simultaneously to a personal computer for analysis, using the Synectics software. Absorbance threshold was set at 0.14 absorbance units and acceptable esophageal pH at 4, to verify fraction of time of bile reflux (absorbance >0.14) and DeMeester score.
Results: Except controls, in whom DeMeester and Johnson scoring and fraction time of absorbance were always normal, all patterns of combined results were observed in GERD and Barrett's patients, showing possibilities of normal pHmetry in patients with detectable bile reflux, normal fraction time of absorbance with pathologic pH recording and both normal in GERD (40%) and Barrett's patients (only 13.3%).
Conclusions: The chapter shows that spectrophotometric measurements combined with 24-hour monitoring of intraluminal pH can offer diagnostic and screening contributions in GERD and Barrett's patients, but cases of normal pHmetry and spectrophotometry demonstrate that none is definitive in characterization of reflux.