Non-acid reflux goes under-diagnosed

You might be suffering from something a lot of doctors fail to check for.

Acid reflux, more commonly known as heartburn, is more than an occasional nuisance.

It's a problem doctors can diagnose and usually treat effectively, but now there's another kind of reflux disease popping up. It may explain why some people don't get better on medication.

They're the usual suspects - fried or fatty foods, coffee, alcohol and garlic. Many types of foods can trigger indigestion, so can over eating, being overweight and even smoking increases your risk of heartburn.

Olivier Hambuckers knows a lot about heartburn. He's not only a patient but a registered nurse in Northwestern's gastroenterology department. Years of stomach juices bubbling back up into his esophagus have caused damage. He's now on medication to control the acid. But sometimes, mysteriously, the reflux returns..

Doctor John Pandolfino said he suspects Hambuckers also has something else going on, something known as non-acid reflux disease.

"Yeah, in the general scheme of things it is something that is often overlooked," said Pandolfino.

That's because in most cases doctors are looking for stomach acid as the culprit. Neutralizing it with medication usually takes care of the burning, indigestion problem. But controlling the acid may not always stop the reflux.

Other liquids from the stomach could still back up into the esophagus. The result is ymptoms such as chronic cough, asthma, indigestion and even regurgitation.

"So any movement of this gastric juice outside and into the esophagus and above is going to give you some symptoms," said Pandolfino.

Not until recently have doctors been able to test for non-acid reflux. That's because typical monitors depend on acid as a signal.

Now, newer monitors can detect reflux when there's no acid present by measuring electrical resistance in the esophagus. The technique is called multichannel intraluminal impedance.

"I can actually see liquid and gas move from the stomach to the esophagus, and I can actually go back independent of the ph or acid level and correlate the reflux movement to the symptoms," Pandolfino said.

For the test, a catheter is placed from the nose into the esophagus. A patient then wears the monitor for 24 hours. Getting the right diagnosis may mean different treatments. With non acid reflux, lifestyle changes, such as eating smaller meals or losing weight, may be enough. Surgery is also an option.

Doctor Marco Patti at the University of Chicago Medical Center said in more severe cases, the right diagnosis could even prevent long-term damage to the lungs.

"We know that there are some patients that can have so much damage to their lungs due to reflux," said Patti.

Hambuckers is now considering the MII test.

"Is it fluid? Is it acid? I don't know, but it does happen once in a while that I feel those symptoms that I felt," he said.

Devices to check for non-acid reflux have been around for several years.. But because of the cost and time commitment needed, not all hospitals offer the test. But experts say if you are on heartburn medication but still experiencing symptoms, you should talk to your physician about other possible causes.

Dr. Marco Patti
Esophageal Surgeon
Marco G. Patti, MD
University of Chicago Medical Center
5841 S. Maryland Avenue, Room G 201
Chicago, IL 60637
(773) 702-4865
Office Fax
(773) 834-1995

Dr. John Pandolfino
Northwestern Memorial hospital
675 N. St. Clair
Galter 17-250
Chicago, Il 60611

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