Gastroesophageal Reflux Symptoms in Typical and Atypical GERD

Roles of Gastroesophageal Acid Refluxes and Esophageal Motility

Tanisa Patcharatrakul; Sutep Gonlachanvit


J Gastroenterol Hepatol. 2014;29(2):284-290. 

In This Article


All patients underwent esophageal manometry and 24 h esophageal pH monitoring at the Gastrointestinal Motility Research Unit, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand during January 2005 to January 2006.

On the testing date, all patients were interviewed regarding the following information using a symptom questionnaire: (i) patient characteristics including age, sex, occupation, underlying medical conditions, previous history of surgery, current use of medications, symptom duration, weight, and height, (ii) the presence of esophageal and upper gastrointestinal symptoms including chest pain, dysphagia, acid regurgitation, heartburn, upper abdominal pain, upper abdominal burning, upper abdominal fullness, abdominal bloating, early satiety, nausea, and vomiting, (iii) the presence of chronic ENT and respiratory symptoms including hoarseness of voice, throat clearing problem, sore throat, burning throat, mucous in the throat, and choking as well as chronic cough. Each symptom was scored 0–3 according to its influence on patients' daily activities: 0, absent; 1, mild (symptoms presented but not interfere with daily activities); 2, moderate (symptoms presented and interfere with but not preclude daily activities); 3, severe (symptoms interfere with daily activities markedly enough to urge modification).[17] This questionnaire has been validated and used in our previous study.[8] The patients who had heartburn and/or acid regurgitation as their main problem were classified as typical reflux symptom, and the patients who had upper abdominal pain or discomfort as their main problem, accompanying with any severity of heartburn and/or acid regurgitation, were classified as reflux-like dyspepsia.

After fasting for at least 8 h, each patient underwent an esophageal manometry to evaluate the esophageal motor functions and to locate the location of the upper border of the lower esophageal sphincter followed by a 24 h esophageal pH testing.

Esophageal Manometry

The esophageal manometry was performed using an eight channel-water perfused esophageal manometry catheter with a Dentsleeve (Dentsleeve's manometry catheter, Mui Scientific Inc., Ontario, Canada) and the state of the art manometry system (Medtronic Inc., Minneapolis, Minnesota, USA). During esophageal manometry study, the resting lower esophageal sphincter (LES) pressure, esophageal contractions in response to 10 swallows of 5 mL water were evaluated. The position of the proximal border of the LES was determined.

The esophageal manometry results was determined as described by S.J. Spechler and D.O. Castell.[18]

24h Esophageal pH Monitoring

After esophageal manometry study, a single or dual channel esophageal pH probe was passed through the nose into the esophagus. The distal and proximal pH sensor was positioned at 5 cm and 20 cm above the proximal border of the LES, respectively. The pH catheter was connected to the pH data logger (Digitrapper pH, Medtronic Inc., Minneapolis, MN, USA). The patients were instructed to record the time of meal ingestions, the time when the patients were in the supine or upright position, and the time when they experienced any symptoms during the study into a study diary. All patients were allowed to have their regular meals except acidic foods/drinks. The time of actual meal ingestions was recorded both on the pH data logger and on the study diary page. All patients reported at the GI Motility Research Unit, King Chulalongkorn Memorial Hospital on the following day in the fasting condition for removal of the pH catheter. The positive pH tests of the lower and upper esophagus were defined as the percent time pH less than 4 at the distal esophagus > 4.5%[19]and at the upper esophagus > 1.0%, respectively.[20]

Statistical Analysis

Data were expressed as mean ± SD or median (interquartile range). Unpaired t-test or χ 2 test was used as appropriate to determine significant difference between two parameters. Stepwise regression analysis was used to determine factor(s) which associated with a positive pH testing result and abnormal esophageal manometry. The data were analyzed using SPSS software for Windows (version 17.0, SPSS Inc, Chicago, IL)