J Korean Med Sci.  2008 Dec;23(6):954-958. 10.3346/jkms.2008.23.6.954.

Normal Ambulatory 24-Hour Esophageal pH Values in Koreans: A Multicenter Study

• Kim GH
• Huh KC
• Lee YC
• Lee KJ
• Choi SC
• Shim KN
• Kim JH
• Lee IS
• Lee HL
• Jung HY
• Park HJ

• KMID: 1107516
• DOI: http://doi.org/10.3346/jkms.2008.23.6.954

Abstract

Ambulatory 24-hr esophageal pH monitoring is considered the gold standard for diagnosing gastroesophageal reflux disease. The aim of this study was to establish normal values for gastroesophageal acid exposure in healthy Koreans. Fifty healthy volunteers (24 males and 26 females; mean age, 45 yr) without reflux symptoms and without reflux esophagitis or hiatal hernia on upper endoscopy underwent ambulatory 24-hr esophageal pH monitoring after esophageal manometry. The 95th percentiles for the reflux parameters were: the percent total time pH <4, 3.7%; the percent upright time pH <4, 5.7%; the percent supine time pH <4, 1.0%; the number of reflux episodes with pH <4, 76.5; the number of reflux episodes with pH <4 for >5 min, 1.5; the duration of the longest episode, 12.5 min; and the composite score, 14.2. Age and gender were not associated with any of the pH parameters. In conclusion, physiological gastroesophageal reflux occurs in healthy Koreans. These normal esophageal pH values will provide reference data for clinical and research studies in Korea.

Keyword

Gastroesophageal Reflux; Ambulatory 24-hr Esophageal pH Monitoring; Reference Values

MeSH Terms

Adult
Age Factors
Aged
*Esophageal pH Monitoring
Female
Gastric Acidity Determination
Gastroesophageal Reflux/*diagnosis
Humans
Hydrogen-Ion Concentration
Korea
Male
Middle Aged
Reference Values
Sex Factors
Time Factors

Reference

1. Tuttle SG, Grossman MI. Detection of gastro-esophageal reflux by simultaneous measurement of intraluminal pressure and pH. Proc Soc Exp Biol Med. 1958. 98:225–227.

2. Miller FA, Dovale J, Gunther T. Utilization of inlying pH probe for evaluation of acid-peptic diathesis. Arch Surg. 1964. 89:199–203.

3. Rokkas T, Sladen GE. Ambulatory esophageal pH recording in gastroesophageal reflux: relevance to the development of esophagitis. Am J Gastroenterol. 1988. 83:629–632.

4. Lam HG, Breumelhof R, Roelofs JM, Van Berge Henegouwen GP, Smout AJ. What is the optimal time window in symptom analysis of 24-hour esophageal pressure and pH data? Dig Dis Sci. 1994. 39:402–409.

5. Jamieson JR, Stein HJ, DeMeester TR, Bonavina L, Schwizer W, Hinder RA, Albertucci M. Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility. Am J Gastroenterol. 1992. 87:1102–1111.

6. Richter JE, Bradley LA, DeMeester TR, Wu WC. Normal 24-hr ambulatory esophageal pH values. Influence of study center, pH electrode, age, and gender. Dig Dis Sci. 1992. 37:849–856.

7. Schlesinger PK, Donahue PE, Schmid B, Layden TJ. Limitations of 24-hour intraesophageal pH monitoring in the hospital setting. Gastroenterology. 1985. 89:797–804.

8. Wiener GJ, Morgan TM, Copper JB, Wu WC, Castell DO, Sinclair JW, Richter JE. Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters. Dig Dis Sci. 1988. 33:1127–1133.

9. Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL 3rd, Castell JA, Castell DO. Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of "abnormal" contractions. Dig Dis Sci. 1987. 32:583–592.

10. Johnson LF, Demeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974. 62:325–332.

11. Stanciu C, Hoare RC, Bennett JR. Correlation between manometric and pH tests for gastro-oesophageal reflux. Gut. 1977. 18:536–540.

12. Hu WH, Wong NY, Lai KC, Hui WM, Lam KF, Wong BC, Xia HH, Chan CK, Chan AO, Wong WM, Tsang KW, Lam SK. Normal 24-hour ambulatory proximal and distal gastroesophageal reflux parameters in Chinese. Hong Kong Med J. 2002. 8:168–171.

13. Yi CH, Chen CL, Lin HH, Chen MC. Esophageal acid exposure in healthy adults in Taiwan: experience with pH step-up method by dualchannel pH-metry. Kaohsiung J Med Sci. 2005. 21:299–303.

14. Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol. 1986. 8:Suppl 1. 52–58.

15. Goldschmiedt M, Barnett CC, Schwarz BE, Karnes WE, Redfern JS, Feldman M. Effect of age on gastric acid secretion and serum gastrin concentrations in healthy men and women. Gastroenterology. 1991. 101:977–990.

16. Kekki M, Samloff IM, Ihamaki T, Varis K, Siurala M. Age- and sex-related behaviour of gastric acid secretion at the population level. Scand J Gastroenterol. 1982. 17:737–743.

17. Feldman M, Cryer B, McArthur KE, Huet BA, Lee E. Effects of aging and gastritis on gastric acid and pepsin secretion in humans: a prospective study. Gastroenterology. 1996. 110:1043–1052.

18. Smout AJ, Breedijk M, van der Zouw C, Akkermans LM. Physiological gastroesophageal reflux and esophageal motor activity studied with a new system for 24-hour recording and automated analysis. Dig Dis Sci. 1989. 34:372–378.

19. Kim JH, Kim HY, Kim NY, Kim SW, Kim JG, Kim JJ, Roe IH, Seo JK, Sim JG, Ahn H, Yoon BC, Lee SW, Lee YC, Chung IS, Jung HY, Hong WS, Choi KW. Seroepidemiological study of Helicobacter pylori infection in asymptomatic people in South Korea. J Gastroenterol Hepatol. 2001. 16:969–975.

20. Murphy DW, Yuan Y, Castell DO. Does the intraesophageal pH probe accurately detect acid reflux? Simultaneous recording with two pH probes in humans. Dig Dis Sci. 1989. 34:649–656.