Twenty-four-hour oesophageal pH studies in rural Eastern Cape Province, South Africa.

BACKGROUND: Recent studies in rural Eastern Cape Province, South Africa, have shown an increased number of non-acid gastro-oesophageal reflux events, an increase in baseline gastric pH compared with other published series, and evidence suggestive of duodenogastric reflux. There are no published data on oesophageal pH in this community or in Africa. OBJECTIVES: To ascertain whether oesophageal pH in this rural community is within normal limits. METHODS: We carried out 24-hour oesophageal pH/impedance studies on 91 participants. Analysis was carried out using computer software to determine 24-hour percentage times of oesophageal pH above 4, 5, 6, 7 and 8. Oesophageal pH during each episode of non-acid reflux was also recorded. RESULTS: Participants were from Canzibe in rural Eastern Cape. Of the studies, 72 were satisfactory and showed 24-hour percentage times with an oesophageal pH >6 of 69.3/35.12/51.16 (upright/supine/total); percentage times with a pH >7 were 12.66/3.44/8.86 and those with a pH >8 were 0.48/0.21/0.37. These results are within the range of other published series. Of episodes of non-acid reflux, 90.2% were associated with an oesophageal pH of 4 - 7. CONCLUSIONS: Baseline oesophageal pH is not significantly affected by the increased numbers of non-acid gastro-oesophageal reflux events reported in this community. If there is a pathogenic effect of non-acid reflux in the Eastern Cape, it does not appear to be mediated through raised oesophageal pH.

Diet affects reflux in a rural African community.

Reflux in this region of South Africa is known to be more frequent and less acidic than in other countries. We investigated the relationship between reflux and diet. We recruited 57 healthy participants. We carried out ambulant oesophageal pH-impedance monitoring for 24 hours. We used software and visual review to analyse data and to identify episodes of reflux and rapid alkaline rises in the stomach. A usual pattern diet questionnaire provided data on frequency of consumption of common foods. Associations between reflux, gastric pH and dietary components were sought using analysis of variance, and regression analyses. Diet was strongly based on maize. Protein was principally from milk, eggs, chicken and beans. Fat was principally from cooking oil. Fruit and vegetables were consumed moderately frequently. Milk consumption was associated with an increase in total reflux (P = .022), weakly acid reflux (P = 0.015) and supine reflux (P = 0.001), and a decrease in the time that gastric pH was higher than 4 (P = 0.030). Fat was associated with an increase in acid reflux (P = 0.046) and a decrease in time that gastric pH was higher than 4 (P = 0.005). Fruit consumption was associated with increases in liquid-only refluxes(P = 0.007), and upright refluxes (P = 0.048). Maize meal was associated with a reduction in rapid alkaline rises in the gastric lumen (P = 0.015). Diet significantly affects reflux in this community. What is normal in apparently healthy people in various parts of the world differs significantly.

Normal values of 24-hour ambulatory esophageal impedance-pH monitoring in a rural South African cohort of healthy participants.

There are no data on 24-hour multichannel intraluminal impedance and pH monitoring in African populations. The purpose of this study was to provide the normal values of esophageal impedance and pH monitoring in a rural African populations. South African healthy rural participants were recruited and underwent 24 hours of esophageal impedance and pH monitoring. The median and the 95th percentiles of the total reflux episodes were 49 and 97, respectively, of which the corresponding number of acidic, weakly acidic, and weakly alkaline reflux were 15 and 55, 17 and 51, and 8 and 36, respectively. The compositions of the total reflux were 5 and 21 for liquid, 27 and 72 for mixed, and 10 and 39 for gas reflux, respectively. The median bolus clearance was 18 seconds and the median bolus exposure was 14 minutes/24 hours. The proximal extent was 6%. The 95th percent time of esophageal exposure to acid was 8.6 in 24 hours. Female and overweight participants were associated with an increased number of reflux events. There were more reflux episodes, and of which, more were weakly alkaline compared with previous similar studies. The findings provide reference values of gastroesophageal reflux for a South African rural population.

Analgesic and anti-inflammatory properties of aqueous extract from leaves of Solanum torvum (Solanaceae).

Solanum torvum is used in Cameroonian traditional medicine for the management of pain and inflammation. The present work assesses the pain-killing and anti-inflammatory properties of the aqueous extracts of Solanum torvum leaves. Acetic acid- and pressure- induced pains were reduced by this extract while carrageenan-induced inflammation was inhibited at various doses of the extract. The extract therefore has both analgesic and anti-inflammatory properties.