Chest
Clinical Investigations: Miscellaneous: ArticlesFrequency and Site of Gastroesophageal Reflux in Patients With Chest Symptoms: Studies Using Proximal and Distal pH Monitoring
Section snippets
Patients
We studied 87 patients referred to the esophageal diagnostic laboratory for evaluation of possible GER associated with asthma (25 patients; 9 male/16 female; mean age, 54 years), chronic cough (28 patients; 10 male/18 female; mean age, 58 years), noncardiac chest pain (34 patients; 15 female/19 male; mean age, 50 years), and compared the results with those obtained in asymptomatic volunteers (27 subjects; 13 male/14 female; mean age, 30 years). All patients with the diagnosis of chest pain had
RESULTS
Figures 1 and 2 illustrate the percent time pH <4.0 at the distal and proximal pH electrodes for all groups during the total study. Median values and quartiles for percent time pH <4 distally (upright, supine, and total) and proximally (total) for all groups are contained in Table 1. All groups showed a statistically significant (p<0.01) longer percent time of acid exposure in the distal esophagus than in the proximal esophagus. All patient groups showed a significant (p<0.01) increase in
DISCUSSION
The effects of refluxed gastric contents may extend beyond the esophagus itself, and may include a number of remote manifestations through anatomic or neural connections to the esophagus.23,31,33 Often termed the “extraesophageal” or atypical manifestations of GER disease, these include asthma, chronic cough, and noncardiac chest pain.8,33
The mechanisms by which GER might precipitate asthma, cough, or substernal chest pain have not been fully clarified. Experimental studies have suggested that
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