Radial esophageal acid exposure and the dilated distal esophagus

Excerpt

With interest we read the article by Ohara et al. [1] published in the recent issue of the Journal of Gastroenterology. Using a novel catheter-mounted multiprobe uni-level pH monitoring system, the authors compared radial acid exposure 2 cm above the manometric lower esophageal sphincter in asymptomatic controls (n = 4), patients with non-erosive reflux disease (NERD, n = 5), and persons with reflux esophagitis (n = 10). Patients with NERD and those with esophagitis showed significantly prolonged acid exposure times on the right side of the distal esophagus (in continuation of the small curvature of the stomach), when compared with findings on the left side (great curvature side of the stomach). Furthermore, this and other recent studies have shown increased severity of endoscopically visible reflux-induced changes on the right versus the left side of the distal esophagus [2]. In addition, three-dimensional (3D) high-resolution manometry has revealed decreased competency within the right-sided portion of the lower esophageal sphincter pressure zone, when compared with the left side [3]. Taken together, the above data and the study by Ohara et al. indicate that the right side of the lower portion of the esophagus is prone to acid/reflux-exposure and reflux injury, when compared with the left side. …