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.

Pattern of gastric emptying in patients with systemic sclerosis

Gastric emptying studies, using an indigenously prepared radiolabeled solid food marker in the form of Indian bread called Chapati, were performed on 13 patients with systemic sclerosis. Six patients had limited cutaneous disease and seven had diffuse cutaneous disease. Earlier, the procedure was standardized in 30 healthy volunteers. Seven of the 13 (54%) patients (five with diffuse and two with limited cutaneous disease) had delayed gastric emptying. Most of these patients had gastric symptoms. This pattern of gastric emptying may be clinically significant, particularly in patients with diffuse cutaneous disease.

Heartburn ulcers

Since esophagitis is increasing in frequency, the authors reviewed case histories of patients with this disorder. The importance of radiographic examination of the stomach and duodenum in patients with esophagitis (heartburn) is stressed.

Gastroesophageal reflux and transit scintigraphy: a comparison with esophageal biopsy in patients with heartburn

A method for combining scintigraphic studies of esophageal transit and gastroesophageal (GE) reflux is presented. Thirty-two patients with symptoms of GE reflux were studied. The severity of their symptoms was compared to nuclear medicine studies and esophageal mucosal biopsy. Fifteen healthy volunteers were studied as a control group for scintigraphy. The sensitivity of reflux scintigraphy to detect GE reflux as determined by esophageal histology was 70% and its specificity 87%. No relationship was observed between the magnitude of symptoms and the volume of GE reflux. A higher incidence of esophageal transit abnormalities was observed in those patients with histologic features of GE reflux than in those with normal histology. The combination of esophageal reflux and transit scintigraphy provides a way of studying some of the esophageal motor abnormalities associated with GE reflux. For clinical purposes GE reflux scintigraphy seems unsuitable as a single screening test.

Heartburn. The role of radiology

There is currently controversy as to the importance of the radiologic demonstration of a hiatal hernia, reflux, or both as the explanation of heartburn. It is clear, however, that clinical-radiologic correlation requires additional observations such as the straightness of the potential path for reflux, the presence of a contractile esophagogastric region, the degree of extrinsic compression of the cuff of the stomach within the hiatus, the size of the hernia, and the peristaltic activity of the body of the esophagus. Vigorous or water-swallowing maneuvers to demonstrate reflux are unreliable in individual cases. Of importance is the concept that the so-called patulous cardia, or effaced abdominal esophagus or widened or absent "submerged segment," is a variety of sliding hiatal hernia that is often neglected radiologically but may be of considerable clinical significance.