Esophageal lesions at irritable bowel syndrome

Aim of investigation. To study potential of рН-impedance measurement in differential diagnostics of esophageal disorders at irritable bowel syndrome (IBS).

Material and methods. Overall 201 patients with IBS, diagnosed according to Rome-III criteria were investigated. Of them 52 were men, 149 — women, mean age was 41,8±9,5 years. In 70 (35%) of them (21men, 49 women, mean age — 42,3±12,0 years) heartburn, belching, epigastric dyscomfort, non-coronary retrosternal pain were present along with IBS. Methods of investigation included clinical examination, esophagogastroduodenoscopy (EGDS) colonoscopy, X-ray investigation of the upper gut, 13С-urease breath test for Helicobacter pylori, 24-hour combined intraluminal рН-impedance recording with estimation of qualitative and quantitative indicators of refluxes and index of symptom-association probability (SAP). Psychometric components were estimated as well: anxiety and depression scores, scores of alexithymia, associated symptoms, quality of life, degree of hyperventilation, index of visceral sensitivity, degree of pain by visual analog scale. The estimation of the mentioned parameters was carried out separately at IBS with esophageal symptoms (n=70) in comparison to other group of investigated patients with IBS (n=131). Statistical analysis of obtained results was carried out by Statistica 6 software.

Results. In 16 (23%) patients instrumental investigation revealed esophagitis of the II–IV degree by Savary–Miller classification. Clinically 6 of them had heartburn, 1 — belching and 9 — combination of heartburn and belching; according to 13С-urease breath test 5 patients had H. pylori infection. In 49 (70%) patients at EGDS and X-ray investigation non-erosive reflux disease (NERD) was revealed. Clinical presentation in this group included heartburn in 10 cases, belching in 16 combination of heartburn and belching — in 12 and postprandial epigastric dyscomfort — 11; 13С-urease breath test was positive in 15 patients. It is noteworthy that in none of patients non-coronary retrosternal pain was associated to esophageal disorders. According to рН-impedance measurement NERD was diagnosed in 20 (33,3%) patients. Functional heartburn was diagnosed in the other 29 (41%) patients.

Conclusion. Nowadays 24-hour combined рН-impedance recording is considered as the most exact method, allowing to reveal gastroesophagal refluxes. In some cases it allows to carry out differential diagnostics between NERD and functional disorders of the esophagus and the stomach in patients with IBS. Application of рН-impedance measurement allows to recommend its introduction in broad clinical practice.

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