Gastric Acidity In Different Phenotypes Of Symptomatic Gastroesophageal Reflux Disease

BackgroundThe present report examines gastric pH from normal subjects and different gastroesophageal reflux disease (GERD) phenotypes to compare the distributions of gastric pH values and of changes in gastric acid concentrations to those reported previously for esophageal pH from the same groups of subjects. I also examined total esophageal acidity as a function of total gastric acidity in the different groups of subjects. MethodsI analyzed 24-hour gastric and esophageal pH recordings from normal subjects and subjects with a particular GERD phenotype to calculate total integrated acidity and total time pH<4. I also examined gastric pH recordings for the distributions of gastric pH values and the distributions of changes in gastric acidity. ResultsThere were different distributions for gastric pH, but virtually identical distributions of changes in gastric acid concentrations in the different groups of subjects. There was a significant positive relationship between total integrated esophageal acidity and total integrated gastric acidity in different GERD phenotypes, but not in normal subjects. The slope of the line relating integrated esophageal acidity to gastric acidity correlated directly with the responses of different GERD phenotypes to PPI treatment reported previously by others. ConclusionsIt seems possible esophageal acidity and gastric acidity can influence each other and by so doing account for the variation in the differences in the distributions of values of pH and acid concentrations among normal subjects and different GERD phenotypes. Furthermore, the strength of the relationship between esophageal and gastric acidity can determine the response to PPI treatment.