[Clinical-phmetric variants in gastroesophageal reflux disease]

Ambulatory pH monitoring, that defines acid reflux episodes as a fall in pH below 4, fail to diagnose weakly acidic reflux, which sometimes is related to the occurrence of symptoms.

To establish the incidence of clinical-phmetric variables that allow to confirm or discard the presence of gastroesophageal reflux and its symptomatic correlation.

[corrected] During a period of 12 months, 100 patients (58 males and 42 females) were consecutively included for 24 hour esophageal ambulatory phmetry. The variables considered were: number of symptomatic episodes during the study, number of episodes with positive symptomatic correlation for pH drop greater than 4, number of episodes with positive symptomatic correlation for pH drop lower than 4 and Demeester score. For operative reasons we divided the patients in six groups: without evidence of acidic reflux (WAR), hypoalgesic pathologic acid reflux (HPAR), normoalgesic pathologic acid reflux (NPAR), hyperalgesic pathologic acid reflux (HyPAR), allodinic pathologic reflux (APR), hyperalgesic physiologic acid reflux (HyPhAR) and allodynic physiologic acid reflux (APhAR).

18% presented WAR, 7% HPAR, 36% NPAR, 14% HyPAR, 18% HyPhAR and 7% APhAR. The patients with pathologic acid reflux presented more episodes with positive symptomatic correlation than patients without pathologic reflux (P = 0.0008). Based on acid reflux intensity and presence or absence of symptomatic correlation, six groups of patients with gastroesophageal reflux disease were differentiated, and probably they should be evaluated and treated in a different way.