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The current recommendations on indications, technical performance, and interpretation of diagnostic techniques for oesophageal reflux update the German recommandations about 24 hour pH measurement of 2003. The recommendations encompass conventional pH measurement, wireless pH measurement, pH and impedance measurements, and bilirubin measurement (duodenogastro-oesophageal reflux)., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Alcoholic beverages are known to increase acidic gastro-esophageal reflux (GER) and the risk of esophagitis. Moreover, duodenogastro-esophageal reflux (DGER), containing bile acids, was shown to harmfully alter the esophageal mucosa, alone and synergistically with HCl and pepsin. However, studies directly addressing potential effects of different low proof alcoholic beverages on DGER in health and disease are missing., Methods: Bilitec readings for beer and white, rose, and red wine were obtained in vitro from pure and from mixtures with bile. One-hour DGER monitoring and pH-metry were performed in 12 healthy subjects and nine reflux patients with DGER after ingestion of a standardized liquid meal together with 300 mL of water, white wine, and in the volunteers, beer and rose wine., Key Results: Bilitec measurement was found to be feasible in the presence of beer, white wine, and using a threshold of 0.25, rose wine. However, the presence of red wine resulted in extinction values above this threshold. The consumption of all investigated alcoholic beverages, especially of white wine, triggered increased acidic GER, both in healthy participants and patients with reflux disease. In contrast, no relevant DGER was found after intake of alcoholic beverages., Conclusions & Inferences: Fiber-optic bilirubin monitoring can be used for DGER monitoring in combination with alcoholic beverages, except with red wine. Low-proof alcoholic beverages are a strong trigger of GER, but not of DGER, both in healthy subjects and patients with reflux disease., (© 2010 Blackwell Publishing Ltd.)

Background: An induction of gastro-oesophageal reflux has been reported after ingestion of alcoholic beverages in healthy volunteers. However, it is unknown whether reflux in gastro-oesophageal reflux disease patients will be enhanced by the ingestion of alcoholic beverages., Aim: To investigate the effects of wine and beer on postprandial reflux in reflux patients., Methods: Twenty-five patients (reflux oesophagitis 15, non-erosive reflux disease 10; 18 men and seven women) drank 300-mL white wine (n = 17), 500-mL beer (n = 8), or identical amounts of tap water (controls) together with a standardized meal in a randomized order. pH-measurement was carried out during three postprandial hours by pH-metry and the percentage of time pH < 4 was calculated., Results: Both alcoholic beverages increased reflux compared with water [wine 23% (median), water 12%, P < 0.01; beer 25%, water 11%, P < 0.05]. Between wine and beer, no difference in reflux induction was obtained. The reflux induction was seen in patients with (23%, P < 0.01) and without reflux oesophagitis (22%, P < 0.05) and in both sexes (women 23%, men 25%, P < 0.05 each)., Conclusions: Ingestion of commonly consumed alcoholic beverages such as wine and beer induces gastro-oesophageal reflux in gastro-oesophageal reflux disease patients. Therefore, these patients should be advised to avoid the intake of large amounts (> or = 300 mL) of these beverages.

Objectives: Before pH measurement, manometry is recommended for precise pH probe positioning. We investigated whether the pH probe could be positioned accurately by the pH difference between the oesophagus and the stomach (pH step-up)., Methods: Dual-channel 24-h pH-metry with probes positioned 5 cm above either the manometrically determined upper lower oesophageal sphincter margin or the pH step-up was performed in healthy volunteers and reflux patients. To determine the pH step-up, the pH probe was pulled back from the stomach until a sudden rise to pH greater than four occurred. Probe position, reflux episodes and the fraction of the time pH was less than four were compared using the Wilcoxon test for difference and the Hodges-Lehman estimate inclusive confidence interval for equivalence. The pH step-up method was evaluated further during proton pump inhibitor therapy and after drug discontinuation., Results: The pH probe was positioned 2 cm and 1 cm closer to the stomach by the pH step-up method in the volunteers and reflux patients, respectively. A small increase in upright reflux episodes but not in supine reflux episodes was registered by the probe positioned by pH step-up. No significant differences in the fraction of the time pH was less than four were obtained between the two probes. The Hodges-Lehman calculation proved equivalence for both methods of probe positioning for 24-h pH-metry. During proton pump inhibitor therapy, no pH step-up was detectable in three volunteers and in one patient. On the first day after discontinuing therapy, the pH step-up method yielded clear-cut results again., Conclusion: The pH probe for diagnostic 24-h pH-metry and, with some limitations, also for 24-h pH-metry for therapy control, can be positioned accurately by the pH step-up method.

This article presents the recommendations for 24-hour oesophageal pH-metry of the German Society of Neurogastroenterology and Motility and the Study Group for Gastrointestinal Functional Disorders and Function Diagnostics of the Austrian Society of Gastroenterology and Hepatology. Indications for the examination, the procedures to be followed, the analysis of the obtained data and the conclusions to be drawn are delineated. The literature on which the recommendations are based is reviewed.

Objectives: White wine has been demonstrated to induce gastroesophageal reflux (GER) in healthy people and GER patients. This GER is characterized by reflux episodes of prolonged duration. Our aim was to explore the pathogenesis of the prolonged reflux duration., Methods: Twelve healthy volunteers received in a randomized order 300 ml of white wine and tap water together with a standardized meal. Esophageal pH and motility were continuously monitored by a glass pH electrode and a strain gauge manometry probe (four measuring points in the esophagus and one in the pharynx to register swallowing) for 90 min after ingestion. Blinded to the ingested beverage, we calculated the fraction of time esophageal pH was <4, the number of reflux episodes and their duration, the swallowing and contraction rate, the contraction amplitude, and the distribution of primary, secondary, simultaneous, and nonpropagated contractions. The motility analysis was separately performed for periods with and without GER. During GER, the time until occurrence of the first contraction, its type, the type of the contraction that raises pH to >4, and the number of peristaltic contractions necessary to raise pH to >4 were also determined. The percentage of GER episodes with simultaneous contractions and failed peristalsis (nontransmitted swallows and nonpropagated contractions) as calculated. The percentage of GER episodes with signs of "rereflux" (further pH drop, common cavity phenomenon in the motility trace) into the acidic esophagus was also determined. The mean reflux duration and the number of peristaltic contractions needed to raise pH to >4 were recalculated by taking the rereflux events into account., Results: White wine significantly increased the fraction of time esophageal pH was <4, reflux frequency, and reflux duration compared to water. During periods without GER, no differences in the motility data were observed between wine and water. During GER, the contraction rate after white wine was significantly lower because of an increase in nontransmitted swallows. The time until occurrence of the first contraction after GER was significantly prolonged after white wine. Primary peristalsis was the main first and clearance contraction type. The percentage of GER episodes with simultaneous contractions and with failed peristalsis was significantly increased with wine. Similarly, the percentage of GER episodes with rereflux was significantly increased. The "corrected" mean reflux duration was still prolonged relative to water, but the difference was no longer significant. The numbers of peristaltic contractions necessary to raise pH to >4, which significantly differed for conventionally defined GER episodes between wine and water, were similar when counted only from onset of the latest rereflux event until pH rose to >4., Conclusions: The pathogenesis of white wine-induced GER episodes of long duration is 2-fold. First, white wine provokes a disturbed esophageal clearance due to an increase in simultaneous contractions and in failed peristalsis. The second mechanism is the occurrence of repeated reflux events into the esophagus when pH is still acidic from a previous reflux episode.

Background: Patients with gastro-oesophageal reflux disease are advised to avoid the ingestion of large meals. In healthy volunteers, a relationship between the amount of postprandial gastro-oesophageal reflux and the volume of a liquid meal has been demonstrated., Aim: To evaluate whether the amount of postprandial gastro-oesophageal reflux is also related to the calorie content of a meal, a second parameter that will be reduced by avoidance of the ingestion of large meals., Methods: Twelve healthy volunteers (six female, 19-31 years) received two solid-liquid meals with either 842 kcal (solid 582 kcal, liquid 260 kcal) or 582 kcal (31% reduction) in a randomized order. The nutritional components (10% fat, 76% carbohydrates, 14% protein) and the volume of the meals were identical in both meals. The lower oesophageal sphincter pressure was measured continuously in the first postprandial hour with a Dent sleeve, and pH-metry was performed for 3 h postprandially with a glass electrode in the distal oesophagus. Blinded to the type of ingested meal, we calculated the mean lower oesophageal sphincter pressure, the frequency of transient lower oesophageal sphincter relaxations, the number of reflux episodes, and the fraction of time for which pH < 4., Results: A similar decrease in lower oesophageal sphincter pressure was observed after ingestion of the high calorie meal (median 10.9 mmHg, range 4.8-16.7 mmHg) and low calorie meal (median 9.9 mmHg, range 3.9-18.4 mmHg). No difference in the number of transient lower oesophageal sphincter relaxations (high calorie: median 9 per hour, range 5-13 per hour; low calorie: median 7 per hour, range 0-14 per hour) and of reflux episodes (high calorie: median 12 in 3 h, range 3-22 in 3 h; low calorie: median 12 in 3 h, range 3-30 in 3 h) was registered after intake of both types of meal. Additionally, no difference was identified regarding the fraction of time for which pH < 4 between the high calorie (mean 2.3%, 0.2-23.7%) and low calorie meal (3.3%, 0.5-17.8%)., Conclusion: Reducing the caloric density of a meal neither influences postprandial lower oesophageal sphincter pressure nor decreases gastro-oesophageal reflux in healthy volunteers. Thus, the amount of gastro-oesophageal reflux induced by ingestion of a meal seems to depend on the volume but not on the caloric density of a meal.

Objective: The reported effects of fatty meals on lower esophageal sphincter pressure (LESP) and gastroesophageal reflux (GER) are controversial. Therefore, the aim of the present study was to reevaluate the effect of isocaloric and isovolumetric low and high fat meals on LESP and GER., Methods: Twelve healthy volunteers (six women, six men, 19 to 31 yr) received an isocaloric (842 kcal) solid-liquid (310 ml with 260 kcal) meal with either a low (10% fat, 14% proteins, 76% carbohydrates) or a high fat content (50% fat, 18% proteins, 32% carbohydrates) in a randomized, double-blinded fashion. The nutritional composition was identical for the solid and liquid part of the meals. In the first post-prandial hour LESP was recorded continuously using a Dent sleeve, and esophageal pH measurement was performed for 3 h postprandially with a glass electrode. We calculated the mean LESP, the frequency of transient LES relaxations (TLESR) and of reflux episodes (RE), the percentage of TLESR with GER, and the fraction time pH <4., Results: For all parameters measured no difference was observed between the low and the high fat meal. Mean LESP amounted to a median of 10.7 mm Hg (range, 7.3 to 15.1 mm Hg) after the low fat meal and to 11.1 mm Hg (5.2 to 16.3 mm Hg) after the high fat meal. The frequency of TLESR (n/1 h) rated to 9 (5 to 13) and 8 (4 to 14), and of RE (n/3 h) to 12 (3 to 22) and 11 (1 to 30). The percentage of TLESR with GER were 37% (0 to 100) and 30% (0 to 78). The fraction time pH <4 amounted to 2.3% (0.2 to 23.7) and 1.8% (0.1 to 28.8) after the low and high fat meal, respectively., Conclusions: In healthy volunteers no difference in post-prandial LESP and GER was seen after a high fat meal compared with an isocaloric and isovolumetric low fat meal. Our results suggest that it is inappropriate to advise GER patients to reduce the fat content of their meals for symptom relief.

Background: White wine and beer induce gastroesophageal reflux (GER). We investigated the effects of white and red wine on lower esophageal sphincter pressure (LESP) and GER., Methods: Twenty healthy volunteers received 300 ml white wine, red wine, or water together with a standardized meal. The LESP was continuously monitored with a Dent sleeve the 1st h postprandially, and the esophageal pH measured with a glass pH electrode., Results: The LESP was decreased after intake of white wine (median, 14.9 mmHg; range, 5.6-19.5 mmHg) compared with red wine (20.4 mmHg; 13.1-22.3 mmHg; P < 0.05) and tap water (19.5 mmHg; 16.2-29.1 mmHg; P < 0.01). The fraction time esophageal pH <4 was increased after both alcoholic beverages compared with tap water (0.9%; 0.2-5.8%; P < 0.01 versus white wine, P < 0.05 versus red wine) with a greater fraction time after white wine (13.2; 0.3-58.1 ) than after red wine (2.3; 0.7-24.4; P < 0.05). The decreased sphincter pressure after white wine was accompanied by a change in the reflux pattern with increased 'stress reflux' and the occurrence of 'free reflux'., Conclusion: White wine and red wine exert different effects on LESP and GER.

Because data on the effects of smoking on gastroesophageal reflux are controversial, we evaluated the effect of smoking on the results of esophageal 24-hour pH-metry in clinical routine. Participants were 280 consecutive patients with symptoms suggestive of reflux disease, 78 smokers, and 202 nonsmokers. Of the smokers, 45 actually smoked during the pH measurement and 33 abstained from smoking. The frequency of reflux episodes, the fraction of time pH was < 4, and the percentage of abnormal 24-hour pH-metry results were compared among actual smokers, abstaining smokers, and nonsmokers. In actual smokers, the effect of smoking on gastroesophageal reflux was further analyzed by comparing the reflux frequency and the fraction of time that pH was < 4 for a 10-minute period before, during, and after smoking. We found no difference in reflux frequency and fraction of time that pH was < 4 among actual smokers, abstaining smokers, and nonsmokers, regardless of a normal or an abnormal pH-metry result. The percentage of patients with a pH-metry result indicating disease was similar in the three groups, at 53%, 52%, and 50%, respectively. Gastroesophageal reflux was not increased during smoking a cigarette or in the postsmoking period compared with the presmoking period. Neither being a smoker nor actually smoking a cigarette had a negative influence on gastroesophageal reflux. Thus smoking or abstaining from smoking does not modify the results of pH-metry in clinical routine.

Background: Patients with reflux disease often complain of heartburn after ingestion of coffee. Induction of gastro-oesophageal reflux has been demonstrated by pH-metry following the intake of coffee in healthy volunteers. The reflux was reduced when the coffee had undergone a decaffeination process. The aim of this study was to investigate the effect of decaffeination of coffee on reflux in patients with reflux disease., Methods: Seventeen reflux patients underwent two osesophageal 3-h pH measurements. The patients received, in a double-blind study design in a randomized order, 300 mL of either regular or decaffeinated coffee together with a standardized breakfast. The fraction time oesophageal pH < 4 was calculated during the three postprandial hours., Results: For regular coffee the fraction time was calculated to a median of 17.9% with a range of 0.7-56.6%. The fraction time was significantly reduced to 3.1% (0-49.9%) after ingestion of decaffeinated coffee., Conclusion: The amount of gastro-oesophageal reflux induced by the intake of regular coffee in patients with reflux disease can be reduce by the decaffeination of coffee.

Unlabelled: The macrolide antibiotic erythromycin has recently been reported to exert profound prokinetic properties. The aim of the study was to investigate the effect of erythromycin on postprandial gastroesophageal reflux in patients with reflux esophagitis., Methods: In 16 patients with reflux esophagitis (according to Savary and Miller: grade I, n = 8; grade II, n = 4; grade III/IV, n = 4) two pH measurements, with and without erythromycin, were performed for three postprandial hours after lunch. Erythromycin was administered in a dose of 3.5 mg/kg intravenously just prior to lunch., Results: With erythromycin, the median fraction time esophageal pH < 4 was significantly decreased (7.6% versus 18.1%; P < 0.05). This decrease was the result of a diminished frequency of reflux episodes (19 vs 25; P < 0.05) and a shortening of the median reflux duration (0.7 min vs 1.1 min; P < 0.05)., Conclusions: Intravenous administration of erythromycin decreases postprandial gastroesophageal reflux in patients with reflux esophagitis.

Background and Objectives: Controversial data are reported on the diagnostic yield of oesophageal pH-monitoring in clinical routine. The aim of this study was to determine the diagnostic importance of oesophageal pH-monitoring in the work-up of functional thoraco-abdominal disorders., Methods: The prevalence of abnormalities in pH-monitoring was evaluated in 238 patients with functional complaints: typical reflux symptoms (n = 56), non-cardiac chest pain (n = 98), non-ulcer dyspepsia (n = 52), and unclassifiable abdominal pain (n = 32). A symptom index was calculated for reflux-related symptoms in patients experiencing symptoms during the measurement (n = 74)., Results: The rate of patients with an abnormal pH-monitoring were in patients with reflux symptoms non-cardiac chest pain, non-ulcer dyspepsia and unclassified abdominal pain 55, 50, 44 and 34%, respectively. A symptom index of at least 50% was observed in 77, 55, 50 and 60% in the four groups respectively., Conclusion: The high rate of abnormal oesophageal pH-monitoring and symptom related reflux events in the investigated patients emphasizes the importance of 24-hour oesophageal pH-measurement in the diagnostic work-up of functional thoracic and abdominal disorders.

Background: Coffee and tea are believed to cause gastro-oesophageal reflux; however, the effects of these beverages and of their major component, caffeine, have not been quantified. The aim of this study was to evaluate gastro-oesophageal reflux induced by coffee and tea before and after a decaffeination process, and to compare it with water and water-containing caffeine., Methods: Three-hour ambulatory pH-metry was performed on 16 healthy volunteers, who received 300 ml of (i) regular coffee, decaffeinated coffee or tap water (n = 16), (ii) normal tea, decaffeinated tea, tap water, or coffee adapted to normal tea in caffeine concentration (n = 6), and (iii) caffeine-free and caffeine-containing water (n = 8) together with a standardized breakfast., Results: Regular coffee induced a significant (P < 0.05) gastro-oesophageal reflux compared with tap water and normal tea, which were not different from each other. Decaffeination of coffee significantly (P < 0.05) diminished gastro-oesophageal reflux, whereas decaffeination of tea or addition of caffeine to water had no effect. Coffee adapted to normal tea in caffeine concentration significantly (P < 0.05) increased gastro-oesophageal reflux., Conclusions: Coffee, in contrast to tea, increases gastro-oesophageal reflux, an effect that is less pronounced after decaffeination. Caffeine does not seem to be responsible for gastro-oesophageal reflux which must be attributed to other components of coffee.

Previous studies have demonstrated an increased gastroesophageal reflux after the ingestion of high-proof alcoholic beverages in normal subjects. Data on gastroesophageal reflux with usual amounts of low-proof alcoholic beverages are not available. The effect of white wine (7.5% v/v, pH 3.2) and beer (7.0% v/v, pH 4.5) was compared with water, a nonalcoholic beverage of pH 3.2, and an ethanol solution (7.5% v/v, pH 7.6) using ambulatory pH measurement in healthy volunteers. The fraction of time at pH < 4 in the first hour after ingestion of 300 ml white wine (median 13.2%) was significantly increased compared with beer (3.6%; P < 0.01), water (0.9%; P < 0.001), ethanol (1.3%; P < 0.001), and the nonalcoholic beverage (0.9%; P < 0.05). Beer provoked significantly more gastroesophageal reflux than water (P < 0.01). It is concluded that white wine and beer induce gastroesophageal reflux, which is neither related to their ethanol content nor to their pH. The mechanism for this effect remains to be identified.

Background: In a previous study it was demonstrated that white wine reduces the lower esophageal sphincter pressure and induces gastroesophageal reflux characterized by reflux episodes of long duration. In the present study, it was evaluated whether wine disturbs esophageal peristalsis and acid clearance. Methods: Twelve healthy volunteers (7F, 23-37 years) received 300 ml white wine (8% vol/vol; WW), an ethanol solution (8% vol/vol; ET) or tap water (WA) together with a standardized meal in a random order. Acid clearance was tested by instillation of 15 ml 0.1 N HCl into the distal esophagus. The number of swallows (dry swallow every 30 sec) were counted until pH rose again above 5. Five wet swallows (5 ml) were applied to test primary peristalsis and five insufflations of 20 ml of air were performed to test secondary peristalsis. Each test was done immediately after and 60 min after ingestion of the beverages. Results: A significantly higher number of swallows were needed to clear the esophagus immediately after ingestion of wine (P < 0.01; median number: WW 12; ET 8; WA 7) due to an increase in the frequency of failed, simultaneous, and low-amplitude contractions. The frequency of triggered secondary contractions was decreased (P < 0.02; WW 70%; ET 100%; WA 100%) and the latency between air injection and onset of secondary peristalsis was prolonged (P < 0.05; WW 9 sec; ET 7 sec; WA 6 sec) immediately after ingestion of white wine. Wet swallow induced primary peristalsis was not influenced by wine. No significant differences in the measured parameters were seen 60 min after ingestion of the three beverages. Conclusion: White wine disturbs temporarily esophageal clearance due to a disturbance of triggering secondary peristalsis and due to an increase in ineffective contractions. The ethanol content alone is not responsible for the effects of white wine on esophageal peristalsis and acid clearance. [ABSTRACT FROM AUTHOR]