[The role of gastroesophageal reflux in the hemorrhaging of esophageal varices. Effect of endoscopic sclerotherapy]

Abstract

From January 1st to December 31st 1987, 51 prospectively selected patients underwent 24-hour intraesophageal pH monitoring before, and 5 weeks after endoscopic paravariceal sclerotherapy (ESCL). Patients were divided into two groups: in group I. first pH monitoring was done 24 hours after acute variceal bleeding; in group II. one month after a previous bleeding episode. Gastroesophageal reflux (GER) was expressed by percentage of time below pH 4, and by average number of reflux episodes, lasting longer than 5 seconds, per hour. In group I. the time below pH 4 (10.3 +/- 2.05%) and the number of reflux episodes (24.4 +/- 4.2/h) were significantly higher, than those in group II. (2.57 +/- 0.14%; 2.39 +/- 0.31/h). Pathologic GER parameters were significantly more frequent in group I. (50% and 73%), than in group II. (16.7% and 29.1%). ESCL significantly reduced GER in both groups of patients. In group I. GER remained pathologic at 12.5% and 20.8% of patients. In group II. time below pH 4 became normal at all of the patients, and only one of them has pathologic number of reflux episodes. Our data give evidence of GER having a possible causative role in initiating variceal bleeding. ESCL significantly reduces GER. This effect might contribute to long term results of ESCL.