J Neurogastroenterol Motil  
Severe Delayed Gastric Emptying Induces Non-acid Reflux up to Proximal Esophagus in Neurologically Impaired Patients
Shinji Ishii,1 Suguru Fukahori,1* Kimio Asagiri,1 Yoshiaki Tanaka,1,2 Nobuyuki Saikusa,1 Naoki Hashizume,1 Motomu Yoshida,1 Daisuke Masui,1 Naoko Komatsuzaki,1 Naruki Higashidate,1 Saki Sakamoto,1 Tomohiro Kurahachi,1 Shiori Tsuruhisa,1 Hirotomo Nakahara,1 and Minoru Yagi1
Departments of 1Pediatric Surgery and 2Division of Medical Safety Management, Kurume University School of Medicine, Fukuoka, Japan
Correspondence to: Suguru Fukahori, MD, PhD
Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
Tel: +81-942-31-7631, Fax: +81-942-31-7705, E-mail: s_fukahori@med.kurume-u.ac.jp
Received: December 13, 2016; Revised: March 4, 2017; Accepted: April 2, 2017; Published online: July 28, 2017.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims
The aim of this study is to investigate the degree of delayed gastric emptying (DGE) and evaluate how the severity of DGE affects gastroesophageal reflux disease (GERD) in neurologically impaired (NI) patients utilizing 24-hour multichannel intraluminal impedance pH measurements (pH/MII) and 13C-acetate breath test (13C-ABT) analyses.
Methods
13C-ABT and pH/MII were conducted in 26 NI patients who were referred to our institution due to suspected GERD. At first, correlation analyses were performed to investigate the correlation between the 13C-ABT parameters and the clinical or pH/MII parameters. Thereafter, all patients were divided into 2 groups (DGE and severe DGE [SDGE] group) according to each cut off half emptying time (t1/2, 90-170 minutes). Each pH/MII parameter was compared between the 2 groups in each set-up cutoff t1/2.
Results
The mean t1/2 of all patients was 215.5 ± 237.2 minutes and the t1/2 of 24 (92.3%) patients were > 100 minutes. Significant moderate positive correlations were observed between both t1/2 and lag phase time and the non-acid reflux related parameters. Furthermore, the patients in the SDGE group demonstrated higher non-acid reflux related parameters than those of the DGE groups when the cutoff was t1/2 ≥ 140 minutes.
Conclusions
The present study demonstrated that GE with t1/2 ≥ 140 minutes was related to an increase of non-acid exposure reaching up to the proximal esophagus in NI patients, and indicating that NI patients with SDGE might have a high risk of non-acid GERD.
Keywords: Breath test; Disabled patient; Gastric emptying; Gastroesophageal reflux; Multichannel intraluminal impedance measurements


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