The Neuroenteric Clinical Research Group, Section of Gastroenterology, Southern Arizona VA Health Care System, University of Arizona Health Sciences Center, Tucson, AZ 85723-0001, USA.
J Clin Gastroenterol. 2012 Aug;46(7):562-6. doi: 10.1097/MCG.0b013e318248f631.
BACKGROUND: Nighttime reflux has been demonstrated to be associated with a more aggressive presentation of gastroesophageal reflux disease (GERD). However, it has remained unknown until now if the difference in nighttime reflux between the different GERD groups is related to the distribution of intraesophageal pH level or duration of acid exposure. AIM: To compare distribution of intraesophageal pH during nighttime between patients with erosive esophagitis (EE) versus those with nonerosive reflux disease (NERD). METHODS: Patients with heartburn symptoms at least 3 times per week were included in this study. Patients were not receiving any antireflux treatment. All patients underwent an upper endoscopy to determine if esophageal inflammation was present or absent. Subsequently, patients underwent ambulatory 24-hour esophageal pH monitoring. Only those with NERD and EE were included in this study. Nighttime period was defined as the time from the moment patients entered the bed to fall asleep and until they woke up the next morning. Distribution of intraesophageal pH during nighttime was generated using a special computer program that analyzed all registered pH measurements. RESULTS: Nineteen patients were found to have NERD and 31 EE. Time in bed was not different between the 2 groups. The mean number of acid reflux events, mean reflux time pH<4, and mean % total time pH<4 during nighttime were significantly lower in the NERD group as compared with the EE group (13.05±4.6, 19.7±7.09, 3.6±1.2% vs. 25.44±4.4, 29.3±7.97, 5.3±1.5%, respectively, all P<0.05). Symptom index for EE was 43.8% versus 21% for NERD, P<0.05. Overall, the distribution of intraesophageal pH during nighttime was similar between NERD and EE patients for all pH ranges. CONCLUSIONS: Patients with EE demonstrated a significantly higher nighttime esophageal acid exposure as compared with NERD, but the overall distribution of the acid exposure was similar between the 2 groups. This suggests that duration rather than intensity of nighttime intraesophageal acid exposure accounts for the difference between EE and NERD.
背景：夜间反流已被证明与胃食管反流病（GERD）的侵袭性表现有关。然而，直到现在，不同 GERD 组之间夜间反流的差异是否与食管内 pH 值分布或酸暴露时间有关仍不得而知。
目的：比较侵蚀性食管炎（EE）与非侵蚀性反流病（NERD）患者夜间食管内 pH 值的分布。
方法：本研究纳入每周至少有 3 次烧心症状的患者。患者未接受任何抗反流治疗。所有患者均行上消化道内镜检查以确定是否存在食管炎症。随后，患者接受 24 小时动态食管 pH 监测。本研究仅纳入 NERD 和 EE 患者。夜间定义为患者从上床入睡到第二天早上醒来的时间。夜间食管内 pH 值分布采用特殊计算机程序生成，该程序分析了所有记录的 pH 值测量结果。
结果：发现 19 例患者为 NERD，31 例为 EE。两组患者卧床时间无差异。NERD 组夜间酸反流事件次数、pH 值<4 的反流时间和 pH 值<4 的总时间百分比均明显低于 EE 组（13.05±4.6、19.7±7.09、3.6±1.2%比 25.44±4.4、29.3±7.97、5.3±1.5%，均 P<0.05）。EE 的症状指数为 43.8%，而 NERD 为 21%，P<0.05。总体而言，NERD 和 EE 患者夜间食管内 pH 值分布在所有 pH 范围内相似。
结论：与 NERD 相比，EE 患者夜间食管酸暴露明显更高，但两组之间酸暴露的总体分布相似。这表明夜间食管内酸暴露的持续时间而非强度差异导致 EE 和 NERD 之间的差异。
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