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.