Examination of gastroesophageal reflux by transabdominal ultrasound: Can a slow, trickling form of reflux be responsible for reflux esophagitis?
L Madi-Szabo | G Kocsis
BACKGROUND: Ultrasound can visualize significant
portions of the upper and lower esophagus; it is without
any instrumental interference in real conditions and
displays events in motion.
PURPOSE: To study the events that occur during
swallowing and gastroesophageal reflux.
PATIENTS AND METHODS: Group 1 comprised 25 patients
with retrosternal complaints, selected for esophageal
surface ultrasonography for endoscopic signs of esophagitis.
Group 2 comprised 25 patients who underwent initial
transabdominal ultrasonography. For 3 to 6 h before
ultrasonography, nothing was given by mouth to the 50
patients labelled as having gastroesophageal reflux
disease (GERD). Ultrasonography was then performed for
15 to 20 mins after drinking one mouthful of water or
tea, or swallowing some saliva to provoke reflux. The
events were recorded on videotape rolls. Endoscopy was
carried out in all 50 cases; in 46 cases (21 and 25
from groups 1 and 2, respectively), gastric acidity
and bacteriology were subsequently examined (test meal).
Manometry and pH were not measured to avoid provocation
of reflux by the instruments. Thirty patients without
any esophageal complaints or signs of esophagitis (though
suffering from gastric and duodenal diseases) were designated
as the control group (group 3). The available results
RESULTS: In 32 of 46 patients diagnosed with
GERD (69.5% in groups 1 and 2), a special kind of reflux
was observed by ultrasonography: a slow, trickling reflux
of the gastric content was seen, mostly after swallowing.
A fast clearance followed four to six episodes of the
trickling reflux, only after an interval of 0.5 to 2
mins. Only fast refluxes and immediate clearance were
observed in the control group.
CONCLUSIONS: The observations above may indicate
a special form of gastroesophageal reflux, namely, a
slow, trickling form of it. It can be responsible for
the development of GERD. Fast reflux and immediate clearance
are common; however, this special trickling form was
observed only in GERD patients. This may explain a number
of often contradictory measurements and can make the
effect of cisapride more understandable. A test meal
is always necessary to distinguish a bilious reflux
from an acidic one, because only the latter may require
aggresive antacidic treatment.