Navaratnam, Romesh Marino; (2002) The evaluation of non acidic reflux and its relevance to gastro oesophageal reflux disease and Barrett's columnar lined oesophagus. Doctoral thesis (Ph.D.), University College London (United Kingdom).

Text The_evaluation_of_non_acidic_r.pdf Download (8MB)

Abstract

There is little acknowledgement in the literature with regard to symptom expression in a non acidic pH range, in particular the neutral (4 - 7) pH range. Data from the current study suggests that 30% of patients with GORD and 38% with Barrett's CLO respectively, experienced the majority of their symptoms within a neutral (4 - 7) pH range. It is widely acknowledged that 90% of bile delivery to the distal oesophagus, arises in the neutral pH range. In addition, alkaline reflux has been significantly implicated in the sequelae of GORD, namely Barrett's CLO and oesophageal junctional adenocarcinoma. The reduction in mucosal sensitivity in Barrett's CLO to acid reflux is widely recognised. A reduction in mucosal sensitivity of the metaplastic epithelium to acid perfusion in GORD (p<0.001) and a control group (p<0.001) was confirmed and also to alkaline perfusion on comparison to a control group (p<0.01) alone. This may account for the large number of Barrett's CLO patients who present de novo with an associated complication such as a junctional adenocarcinoma. Antroduodenal dysmotility has been implicated in the pathogenesis of duodenogastro oesophageal reflux, which is relevant to bile delivery to the distal oesophagus. Non invasive assessment of antroduodenal motility, utilising electrogastrography (EGG ) and antral ultrasound, revealed marked antroduodenal dysmotility in both Barrett's CLO (p<0.01) and GORD (p<0.01) in the pre and post prandial phases, Barrett's CLO (p<0.001); GORD (p<0.05), in comparison to a control group. In addition, an increased prevalence of brady and tachyarrthymias was noted in Barrett's CLO, which was most marked in the post prandial phase. This may partly explain the increased presence of bile in the oesophageal refluxate in Barrett's CLO patients and thus their recognised increased morbidity. The rationale for the aggressive evaluation, of symptomatic reflux in a non acidic pH range, utilizing bilitec in combination with antroduodenal assessment and perhaps impedance in the future, is justified by the knowledge that patients who experience the majority of their symptoms within a non acidic pH range are increasingly prone to the serious sequelae of GORD. Such patients should be considered for anti reflux surgery as there is now increasing evidence supporting the prophylactic role of anti reflux surgery in the preventative management of junctional malignancy.

Download activity - last month

Export as XMLCSVJSON

Download activity - last 12 months

Export as XMLCSVJSON

Downloads by country - last 12 months

Export as XMLCSVJSON

Archive Staff Only

View Item