Heartburn correlated to 24-hour pH monitoring and radiographic examination of the esophagus

OBJECTIVES

Study relationship of gastroesophageal reflux disease to findings on radiographic examination of the esophagus.

METHODS

We correlated heartburn (HB) in 360 patients (174 women; 186 men; mean age, 53 yr) to results of pH monitoring (pHM) and radiographic examination of the esophagus. Radiographic findings were categorized as normal (n = 129), hiatal hernia (HH) only (n = 173), reflux esophagitis (n = 50), or peptic stricture (n = 8) (ES; 58). Abnormal pHM was defined as total percentage of esophageal acid exposure time (pH < 4) of 6% or greater.

RESULTS

pHM was abnormal in 41 (31%) of 132 patients with HB versus 54 (24%) of 228 without the symptom (p > 0.05). Radiographic correlation showed abnormal pHM in only 21 (16%) of 129 patients with a normal esophagus, 52 (30%) of 173 with HH, and 22 (38%) of 58 with ES, which was significantly lower for those with a normal esophagus. In 132 patients with HB, those with normal esophagus had lower abnormal pHM (2 of 38; 5%) compared with patients with HH (24 of 64; 38%) or with ES (15 of 30; 50%) (p < 0.05). In the 228 patients without HB, abnormal pHM was found in 19 (21%) of 91 with a normal esophagus, 28 (26%) of 109 with HH, and 7 (25%) of 28 with ES (p > 0.05).

CONCLUSIONS

(1) pHM findings did not correlate with presence or absence of HB; (2) pHM is usually normal in patients with normal esophagus on RE; (3) pHM is also usually normal in patients with HB and normal esophagus on RE; and (4) pHM is often normal in patients with radiographic findings of reflux esophagitis or peptic stricture.

Correlation of lower esophageal mucosal ring and 24-h pH monitoring of the esophagus

OBJECTIVE

To study the relationship of LEMR and gastroesophageal reflux. The pathogenesis of the lower esophageal mucosal ring (LEMR) is not known. The most likely theory is that the ring results from reflux esophagitis as part of the morphological spectrum of peptic stricture.

METHODS

We correlated barium esophagrams and 24-h pH monitoring (pHM) in 343 patients (173 women, 170 men; mean age 52 yr). Patients were categorized into three groups by radiographic findings: 1) normal esophagus (n = 121), 2) hiatal hernia (HH) only (n = 174), and 3) LEMR (n =48). Abnormal pHM was defined as a total percentage of the esophageal acid exposure time of 6% or more; abnormal pHM was also analyzed relative to patient position (supine vs. upright).

RESULTS

Findings showed that 21 (17%) of 121 normal patients had abnormal pHM compared with 58 (33%) of 174 patients with HH and 15 (31%) of 48 patients with LEMR. Normal patients had a significantly lower frequency of abnormal pHM (p < 0.01) vs. the other two groups; however, no significant difference in results of pHM was found in the groups with HH and LEMR. No significant relationships of abnormal supine versus upright pHM was observed comparing the three groups.

CONCLUSIONS

1) Most patients in this study had normal pHM, regardless of the anatomic status of the esophagogastric region; 2) patients with HH and LEMR had a higher frequency of abnormal pHM, although the two groups were not significantly different; and 3) an etiological relationship of LEMR and gastroesophageal reflux was not supported, other than its association with HH.

Association of hiatal hernia and gastroesophageal reflux: correlation between presence and size of hiatal hernia and 24-hour pH monitoring of the esophagus

OBJECTIVE

The relationship of hiatal hernia to gastroesophageal reflux disease remains controversial. Previous endoscopic and radiologic studies of hiatal hernia and reflux esophagitis have shown that hiatal hernia is a poor predictor of the presence of endoscopic esophagitis, especially for smaller hernias. Similar correlations with 24-hr pH monitoring have not been done. The purpose of this study was to determine if there is a correlation between the presence and size of hiatal hernias and gastroesophageal reflux using 24-hr pH monitoring as a measure of the degree of reflux.

MATERIALS AND METHODS

We reviewed the barium esophagograms and the results of pH monitoring of the esophagus in 319 patients (161 women and 158 men; mean age, 51 years). The presence and size of hiatal hernia were determined from the radiographic examination; size was categorized as "minimal" or "larger" (> or = 2 cm axial length). An abnormal result of pH monitoring was defined as a pH less than 4 for 6% or more of the 24-hr observation time.

RESULTS

Abnormal results of pH monitoring were found in 61 (31%) of 199 patients with hiatal hernia compared with 21 (18%) of 120 patients without hiatal hernia (p < .05). Abnormal findings of pH monitoring were present in 33 (35%) of 95 patients with a larger hiatal hernia versus 28 (27%) of 104 patients with a minimal hiatal hernia (p > .05); a significant difference (p < .05) was observed when patients without hiatal hernia were compared with those with a larger hiatal hernia.

CONCLUSION

Most patients in this study had normal results of pH monitoring of the esophagus regardless of the presence or absence of hiatal hernia. However, patients with larger hiatal hernias were more likely to have abnormal findings on pH monitoring; hiatal hernias of minimal size were a poorer predictor of the presence of abnormal gastroesophageal reflux.

Association of hiatal hernia and gastroesophageal reflux: correlation between presence and size of hiatal hernia and 24-hour pH monitoring of the esophagus

OBJECTIVE

The relationship of hiatal hernia to gastroesophageal reflux disease remains controversial. Previous endoscopic and radiologic studies of hiatal hernia and reflux esophagitis have shown that hiatal hernia is a poor predictor of the presence of endoscopic esophagitis, especially for smaller hernias. Similar correlations with 24-hr pH monitoring have not been done. The purpose of this study was to determine if there is a correlation between the presence and size of hiatal hernias and gastroesophageal reflux using 24-hr pH monitoring as a measure of the degree of reflux.

MATERIALS AND METHODS

We reviewed the barium esophagograms and the results of pH monitoring of the esophagus in 319 patients (161 women and 158 men; mean age, 51 years). The presence and size of hiatal hernia were determined from the radiographic examination; size was categorized as "minimal" or "larger" (> or = 2 cm axial length). An abnormal result of pH monitoring was defined as a pH less than 4 for 6% or more of the 24-hr observation time.

RESULTS

Abnormal results of pH monitoring were found in 61 (31%) of 199 patients with hiatal hernia compared with 21 (18%) of 120 patients without hiatal hernia (p < .05). Abnormal findings of pH monitoring were present in 33 (35%) of 95 patients with a larger hiatal hernia versus 28 (27%) of 104 patients with a minimal hiatal hernia (p > .05); a significant difference (p < .05) was observed when patients without hiatal hernia were compared with those with a larger hiatal hernia.

CONCLUSION

Most patients in this study had normal results of pH monitoring of the esophagus regardless of the presence or absence of hiatal hernia. However, patients with larger hiatal hernias were more likely to have abnormal findings on pH monitoring; hiatal hernias of minimal size were a poorer predictor of the presence of abnormal gastroesophageal reflux.

Globus pharyngeus: radiographic evaluation and 24-hour pH monitoring of the pharynx and esophagus in 22 patients

PURPOSE

The authors correlated the radiographic evaluation and 24-hour pH monitoring of the pharynx and the esophagus in patients with globus pharyngeus.

MATERIALS AND METHODS

Radiographic examination of the pharynx of 22 patients (13 women and nine men, aged 23-73 years [mean, 47 years]) included videofluoroscopy and static radiography. Twenty-four-hour double-probe pH monitoring of the pharynx (abnormal, pH < 4) and esophagus (abnormal, 6% or more total acid exposure) was performed in all patients.

RESULTS

Radiographic results were normal in 17 patients; results were abnormal in five, with four having pharyngeal dysfunction and one showing a persistent cricopharyngeal impression. Zenker diverticulum was not seen. Results at pH monitoring of the pharynx and esophagus were normal in 20 and 18 of the 22 patients, respectively. In four of five patients with abnormal radiographic studies of the pharynx, results of pharyngeal pH monitoring were normal.

CONCLUSION

Most patients with globus pharyngeus had normal results at pH monitoring and radiographic examination of the pharynx.

Arachidonic acid metabolites: effects on inflammation of fetal rabbit excisional wounds

Uncovered fetal rabbit excisional wounds do not exhibit any classic signs of healing; wounds covered with an impermeable cover do contract, reepithelialize, and exhibit inflammation. Prostaglandin E2 (PGE2) is elevated in amniotic fluid, acting as an immunosuppressant at the maternal-fetal interface. Full-thickness excisional wounds were made on 25-day gestational age rabbit fetuses. Half the wounds were covered with an impermeable cover. Tissue from covered, uncovered, and nonwounded fetuses was examined 72 h after wounding for arachidonic acid metabolites. Uncovered wounds had significantly (P less than or equal to 0.05) elevated levels of PGE2, PGF2 alpha, and 12-HETE versus covered wounds and control tissue. Covered wounds had significantly elevated levels of 15-HETE compared to uncovered and control tissue. The elevated PGE2 in uncovered wounds may act as a fetal immunosuppressant; covered wounds (lower PGE2) developed cellular inflammation. Further investigations of these interactions may permit modulation of adult inflammation.

Monodelphis domesticus: a model for early developmental wound healing

Fetuses heal significantly differently than adults; amniotic fluid and the fetal environment have profound effects on the fetus' response to excisional wounding. The Brazilian gray short-tailed opossum (Monodelphis domesticus) is presented as a new model for early developmental wound healing. This is a small, docile, pouchless marsupial whose young, at birth, are equivalent to an 8-week gestational age human, which allows investigations of early developmental wound healing exclusive of the amniotic environment. Incisional and excisional wounds were made on the dorsum of pups 1 or 15 days after birth. The pups were killed 1, 3, or 6 days after wounding and were fixed for histology. All incisional wounds were bridged by keratinocytes within 24 hours. Day 1 excisional wounds healed 6 days after wounding with a hypertrophic layer of keratinocytes and no inflammation. Day 15 excisional wounds exhibited inflammation, focal necrosis, and healing by epithelial migration 6 days after wounding. This model allows for investigations into early developmental wound healing and exhibits responses dependent on age similar to prepartum and postpartum young of higher mammals.

The effects of partial and total amniotic fluid exclusion on excisional fetal rabbit wounds

Previous studies have consistently demonstrated that fetal rabbit excisional wounds exposed to amniotic fluid do not heal in utero. This study examines fetal wounds covered to exclude amniotic fluid. Full-thickness excisional wounds were created on fetal rabbits on day 25 of gestation. The following three treatment groups were examined: uncovered (n = 19 live); covered, a silicone cover was sutured over the wound (n = 14 live); and donut, a silicone cover containing a 2-mm central hole was sutured over the wound (n = 6 live). Fetuses were returned to the uterus and harvested by cesarean section 72 hr postoperatively. Fetal (covered) wounds excluded from amniotic fluid contracted and reepithelialized up to confluence. Sixteen of 19 uncovered wounds expanded, 3 were unchanged; minimal reepithelialization was present in all wounds. Partially (donut) covered wounds exhibited an intermediate response. This study shows that excisional wounds in the rabbit fetus respond to injury by contracting and reepithelializing when excluded from amniotic fluid.

Cellular inflammation of fetal excisional wounds: effects of amniotic fluid exclusion

The development of an cellular inflammatory response secondary to mechanical wounding has not been observed previously in the fetus. The effect of amniotic fluid exclusion on the inflammatory response in fetal rabbits subjected to full-thickness dorsal excisional wounds on day 25 of gestation (term = 31-32) was examined. The fetuses were either returned immediately to the uterus; a silicone cover was sutured over the wound; or a silicone cover with a centrally located hole was sutured over the wound. Seventy-two hours after wounding, uncovered wounds (19 live fetuses) exhibited only occasional inflammatory cells. Covered wounds (14 live fetuses) showed a pronounced cellular inflammatory response. Partially covered wounds (six live fetuses) showed a peripheral, intermediate response. The findings suggest that amniotic fluid contains factors inhibitory to inflammation, which the cover effectively excludes.