Relationship between mixed acid-alkaline gastroesophageal reflux and esophagitis

The severity of reflux esophagitis is related to the potency of refluxed material and the duration of its contact with the esophageal mucosa. The occurrence of esophagitis in patients with gastric hyposecretion or even with achlorhydria has focused attention on nonacid gastroduodenal contents. Until analytical studies of refluxed material are available to clarify its composition, the 24-hour combined gastric and esophageal pH monitoring can be used for detecting gastroesophageal reflux and for trying to analyze the composition of the refluxate. The first problem of this investigation was to examine whether the mixed acid-alkaline reflux, defined by pH monitoring, represented reflux of duodenal content; the second to study if there was a correlation between this type of gastroesophageal reflux and esophagitis. Unequivocal grade II and III esophagitis were considered. Our data suggest that the mixed acid-alkaline gastroesophageal reflux represents reflux of duodenal contents into the stomach and successively into the esophagus. The higher incidence of endoscopic-proven esophagitis in patients with mixed acid-alkaline gastroesophageal reflux in comparison to patients with acid gastroesophageal reflux supports the concept that biliary and pancreatic secretions may be a contributory factor in esophageal injury.