Heartburn: the acid reflux is not the only cause

The acidity of gastro-oesophageal reflux is not enough to explain the sensation of heartburn, according to a published in "Gut" Dutch study. All gastro-oesophageal reflux does not cause heartburn and are called, in this case, asymptomatic. However, the origin of this lack of symptoms remains poorly understood.
To determine the factors responsible for the perception of heartburn, Dr. Bredenoord, Department of Gastroenterology, St Antonius (Netherlands) Hospital, and colleagues conducted a study of 32 patients with symptoms suggestive of gastroesophageal reflux disease (GERD). Volume, acidity and severity of reflux into the esophagus were measured using a pH test but also with a more accurate impedance technique.

Among the 20 patients with at least one episode of reflux associated with heartburn, the characteristics of symptomatic and asymptomatic episodes were compared. Among the 1807 reflux episodes occurred in these patients, 203 episodes have resulted in a feeling of heartburn.

Reflux associated with heartburn were associated with a greater increase in acidity and a higher extent in the esophagus, a larger volume and a longer elimination of reflux time, compared with reflux symptoms.

In addition, 14.8% of symptomatic reflux proved weakly acidic, demonstrating that acidity alone can not explain the occurrence of heartburn. In addition, the researchers found that reflux consisting only of gas can also induce heartburn. But today all available treatments target the acidity, the authors note.