Correlation of 24-hr esophageal pH patterns with clinical features and endoscopy in gastroesophageal reflux disease

We performed 24-hr ambulatory esophageal pH monitoring in north Indian patients with gastroesophageal reflux disease (GERD) and correlated it with symptom severity and endoscopic abnormalities. Thirty-six consecutive patients with symptomatic GERD and 16 healthy volunteers underwent objective grading of clinical symptoms and endoscopic findings. Total, supine, and upright reflux periods as well as frequency and duration of reflux episodes were determined from the 24-h pH-metry record using standard software. This was abnormal in 32 patients, who could be categorized into upright refluxers (31.2%), supine refluxers (34.4%), and combined refluxers (34.4%). Supine reflux and upright reflux were distinct entities that did not correlate with each other (r = 0.22, P = NS). In upright refluxers, symptoms (P < 0.02) and endoscopic abnormalities (P < 0.005) were milder than in combined refluxers. Total duration of acid exposure correlated significantly with severity of symptoms (P < 0.001) and endoscopic esophagitis (P < 0.005). Patients with GERD had three distinct patterns of abnormal gastroesophageal reflux, with upright refluxers having milder disease and supine and combined refluxers having more severe disease. This may reflect differences in underlying mechanisms of reflux.