Joelsson B., Johnsson F. Heartburn - the acid test. Gut: 1989. Vol. 30. P. 1523-1525.

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Авторы: Joelsson B. / Johnsson F.

Heartburn - the acid test

B Joelsson and F Johnsson

From the Department of Sulrgery, Llund Univ'ersity, Sweden

SUMMARY To determine whether symptoms of gastro-oesophageal reflux are related to the degree of oesophageal acid exposure, 190 patients (of 220 referred) with heartburn and acid regurgitation were compared with 50 normal subjects. A definite relationship between frequency of reflux symptoms and degree of oesophageal acid exposure was found both in patients with and without oesophagitis. We conclude that the frequency of gastro-oesophageal reflux symptoms is related to degree of oesophageal acid exposure.

Dyspepsia is a condition mainly characterised by the lack of a distinct definition. Symptoms vary from mild flatulence to severe epigastric pain and may be caused by colonic dysmotility, gall stones, peptic ulcer, cancer and oesophagitis. Dyspepsia is a common complaint and often treated without further investigation. An attempt was recently made to analyse dyspeptic symptoms into more distinct subgroups in order to give better guidelines for treatment. One subgroup suggested was "gastrooesophageal reflux-like dyspepsia" mainly characterised by "substernal or epigastric discomfort and heartburn, a burning upper epigastric pain, regurgitation of acid and occasionally food". If these symptoms are caused by acid exposure of the oesophageal mucosa, it would be logical to prescribe acid reducing antireflux therapy. Oesophageal symptoms, however, may be caused not only by acid gastro-oesophageal reflux, but also be oesophageal dysmotility and diseases in adjacent thoracic and upper abdominal organs. The present study was performed to investigate whether patients with reflux-like dyspepsia actually do have increased acid exposure of the oesophagus.

Figure Acid exposure of the distal part of the oesophagus during eigit three hour periods expressed as median % time spent with pH <4 in 190 patients with different degrees of heartburn and acid regurgitation (see Methods) and 50 asymptomatic endoscopically normal subjects.

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