Quote from the abstract: "Out of the 45% of patients who were asymptomatic or returned normal endoscopies, half returned positive esophageal pH tests. In turn, among the 55% of patients who had symptoms or an abnormal upper endoscopy, three quarters had pH tests that diagnosed reflux."
The "in turn" phrasing suggests that the 45% and the 55% correspond to two mutually exclusive groups, together covering all the patients - is that what the authors mean?
If yes than one of the "or"s should be an "and" instead. Which one?
Article Frequency of abnormal esophageal acid exposure in patients e...
As the abstract also writes that "20% returned abnormal upper endoscopy results" if the answer to the first question is yes it must be the first "or" to change to an "and":
Out of the 45% of patients who were asymptomatic AND returned normal endoscopies, half returned positive esophageal pH tests.
Why don't you contact he authors directly and learn from them what they ment?!
To me, the statements elicit no particular concerns. I would regard the term, in turn as in contrast; and both are "or": the 1st cohort includes patients with no symptom OR who underwent endoscopy for whatsoever reason but turned out to be normal, whereas, the participants in the 2nd cohort are either symptomatic OR have abnormal findings in the scopy.
Specific to the question asked, the use of the word "or" is accurate and defines the heterogeneous group of patients who had either normal endoscopy or were asymptomatic. Similarly the term "in turn" could be expressed as "alternatively" and also refers to the heterogeneous group of patients with symptoms or abnormal upper endoscopy. The findings of the study are interesting but certainly not surprising.
Gastroesophageal reflux disease is actually a degenerative disease of progressive destruction of the sphincter due to overeating and therefore distention of the fundus and exposure of the distal lower esophageal sphincter to the acid pocket leading to progressive destruction and shortening of the sphincter. The normal stomach is designed to accommodate a meal of approximately 750 cal, and when this is exceeded, there is progressive overdistention of the fundus and Cardia with effacement of the lower esophageal sphincter leading to a reflux event. So in a way, the development of obesity, which is essentially food consumption in excessive quantities that likely exceed that 750 cal limit will naturally be associated with increased amounts of reflux. However it is not simply the obesity with the attendant increased intra-abdominal pressure that is the etiology for the reflux episode. To be sure, once the degenerative process has begun, which is in advance of the severity of the obesity, there is a lower gastric yield pressure required for a reflux event to occur. Therefore as BMI increases and obesity develops, the increased intra-abdominal pressure only helps to increase the amount of reflux due to an already compromised sphincter. The variability in the pH studies is not unexpected. In fact it has been clearly demonstrated that even in patients on proton pump inhibitors who are entirely asymptomatic, only 50% will have normal pH studies. Unfortunately the dependence upon the arbitrary quantification of pH studies borders on being a false God. It is truly this focus on acid reflux that has allowed the unchecked proliferation of the use of proton pump inhibitors essentially eliminating symptoms without correcting the continued progressive degeneration of the sphincter. This then allows and accounts for the geometric increase in cancer of the esophagus, secondary to medication-masked and unnoticed increasing daily frequency of reflux and amount of time overall reflux has been occurring.
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