Concomitant Duodenogastric and Gastroesophageal Reflux: The Role of Twenty-Four-Hour Gastric pH Monitoring

Abstract

Duodenogastric reflux can occur in patients with gastroesophageal reflux disease (Pellegrini et al. 1978; Little et al. 1984; DeMeester 1985a). Its presence is suggested symptomatically by epigastric pain, nausea, and vomiting in addition to heartburn and regurgitation; endoscopically by a large bile lake or evidence of gastritis; and functionally by a normal 24-h esophageal pH monitoring test in a patient with a mechanically defective lower esophageal sphincter (LES), i.e., LES pressure less than 6 mmHg, LES overall length 2 cm or less, and LES intraabdominal length 1 cm or less (Toye and Williams 1965; Ritchie 1984; DeMeester 1985 b).