Twenty-four-hour ambulatory esophageal pH monitoring in patients with symptoms of gastroesophageal reflux.

We investigated the relationship between gastric acid reflux patterns and esophageal mucosal damage in 142 patients with symptoms suggestive of gastroesophageal reflux and esophagitis. Each patient underwent endoscopy of the esophagus and 24-hour ambulatory esophageal pH monitoring. Endoscopy revealed varying degrees of esophagitis in 37 patients and a normal esophagus 105 patients. No significant difference in symptoms was found between patients with and without esophagitis. Sixteen of the 37 patients with esophagitis had a normal composite score on pH monitoring, whereas 24 of the 105 patients without esophagitis had an abnormal composite score (p < 0.001). Comparison of individual pH parameters during the study showed more reflux episodes (pH < 4), a higher percentage of reflux time, and more reflux episodes longer than 5 minutes in the group with esophagitis than in the without (p < 0.05). Both the percentage of reflux time and the number of reflux episodes longer than 5 minutes/hour were significantly higher (p < 0.05) in the group with endoscopically proven esophagitis in the supine period, but not in the upright period. There was a positive correlation between the severity of endoscopic esophagitis and the percentage of reflux time in the supine period (r = 0.64; p < 0.001), and the number of reflux episodes longer than 5 minutes/hour in the supine period (r = 0.56; p < 0.001). In conclusion, our patients with peptic esophagitis had significant gastric acid reflux and impaired acid clearance by the esophagus in the supine position. We advocate that 24-hour ambulatory esophageal pH monitoring should be considered in Chinese patients with normal endoscopy findings but with symptoms suggestive of gastroesophageal reflux disease.