The Pattern of Esophageal Acid Exposure in Gastroesophageal Reflux Disease Influences the Severity of the Disease

HYPOTHESIS: There is an independent association between the different patterns of esophageal acid exposure in gastroesophageal reflux disease and the severity of the disease. DESIGN: Case-comparison study. SETTING: Department of surgery at a university hospital. PATIENTS: A group of 401 patients with increased esophageal acid exposure divided into 4 groups according to the pattern of reflux: postprandial (n = 41), upright (n = 74), supine (n = 129), and bipositional (n = 157). MAIN OUTCOME MEASURES: The prevalence of mucosal injury and the status of the lower esophageal sphincter and esophageal motility were assessed in each group. RESULTS: The likelihood of having indicators of the severity of gastroesophageal reflux disease increases progressively from postprandial to upright, supine, and bipositional reflux. CONCLUSIONS: The pattern of esophageal acid exposure in gastroesophageal reflux disease is an objective predictor of the severity of disease and could be used for therapeutic decisions.