Hanneke Beaumont, MD, PhD
Academic Medical Center
Department of Gastroenterology and Hepatology
Amsterdam, The Netherlands
Hanneke Beaumont received her M.D. from the University of Amsterdam, The Netherlands and started in 2004 as a PhD fellow at the Department of Gastroenterology and Hepatology at the Academic Medical Centre in Amsterdam. She worked, under supervision of Professor Guy Boeckxstaens, on the pathofysiology of gastroesophageal reflux disease. This resulted in a dissertation in 2008. Currently, Hanneke Beaumont is a resident trainee in gastroenterology.
Title: The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD.
Hanneke Beaumont, Roelof J Bennink, Jan de Jong, Guy E Boeckxstaens.
Gut 2010;59:441-451 Published Online First: 2 August 2009
Background & Aims: Gastro-oesophageal reflux occurs twice as much during transient lower oesophageal sphincter relaxations (TLOSRs) in patients with gastro-oesophageal reflux disease (GORD) compared to healthy volunteers (HVs). Our aim was to assess whether the localisation of the postprandial acid pocket and its interaction with a hiatal hernia (HH) play a role in the occurrence of acidic reflux during TLOSRs.
Methods: Ten HVs and 22 patients with GORD (12 with HH<3 cm (s-HH), 10 with HH≥3 cm (l-HH)) were studied. The squamocolumnar junction and diaphragmatic impression were marked with a radioactively labelled clip. To visualise the acid pocket, 99mTc-pertechnetate was injected intravenously and images were acquired up to 2 h postprandial. Concurrently, combined manometry/impedance and four-channel pH-metry were performed, with pH pull-through at multiple time-points.
Results: The rate of TLOSRs and the per cent associated with reflux was comparable between all groups. However, acidic reflux was significantly increased in patients, especially in patients with l-HH. Acid pocket length was significantly enlarged in patients. Moreover, immediately before a TLOSR, the acid pocket was more frequently located within the hiatus or above the diaphragm in patients with GORD (s-HH, 54%; l-HH, 77%) compared to HVs (22% of TLOSRs). Acidic reflux was significantly increased when the acid pocket was located above the diaphragm in all groups compared to a sub-diaphragmatic localisation.
Conclusions: The position of the acid pocket is largely determined by the presence of a HH. Entrapment of the pocket above the diaphragm, especially in patients with l-HH, is a major risk factor underlying the increased occurrence of acidic reflux during a TLOSR in patients with GORD.