Elimination of reflux symptoms does not guarantee normalization of pH

Many patients with gastroesophageal reflux disease and without Barrett's esophagus continue to exhibit pathologic GERD and low intragastric pH despite symptom resolution, find researchers in the American Journal of Gastroenterology.

Acid plays a significant role in the development of gastroesophageal reflux symptoms.

It is thought that acid suppressive therapy improves or eliminates symptoms by normalizing pH.

In this study, researchers from the United States assessed whether proton-pump inhibitors (PPIs) normalized intraesophageal and intragastric pH in 50 patients with GERD. Patients did not have Barrett's esophagus and were rendered symptom free by therapy.

The team evaluated patients using dual-sensor 24-h pH monitoring while they were receiving PPI therapy for complete control of GERD symptoms.

50% of patients had abnormal intraesophageal pH profiles.

American Journal of Gastroenterology

The team then analyzed the patients' intraesophageal and intragastric pH profiles.

The researchers found that 50% of patients had abnormal intraesophageal pH profiles despite adequate symptom control. This was associated with significant breakthrough of intraesophageal acid control in both the upright and supine positions.

The team determined that low intragastric pH correlated highly with intraesophageal acid reflux only in patients with persistent abnormal esophageal acid exposure.

Dr David Milkes's team concluded, "50% of patients with GERD without Barrett's esophagus continue to exhibit pathologic GERD and low intragastric pH despite PPI therapy that achieves complete reflux symptom control".