Esophageal symptoms versus epigastric symptoms: Relevance for diagnosis of gastroesophageal reflux disease

Meng Yu Zhang, Nian Di Tan, Yu Wen Li, Daniel Sifrim, John E. Pandolfino, Ying Lian Xiao*, Min Hu Chen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Although pathological acid reflux in patients with reflux symptoms is uncommon, it affects one-third of patients with epigastric symptoms in China. The aim of this study was to evaluate and compare the relevance of esophageal and epigastric symptoms in diagnosing gastroesophageal reflux disease (GERD) in China. Methods: Consecutive outpatients with predominantly esophageal symptoms (heartburn, regurgitation, chest pain, dysphagia) or predominantly epigastric symptoms (epigastric pain, epigastric burning, early satiety, postprandial fullness) were enrolled. Patients underwent upper endoscopy and esophageal function tests, and took proton pump inhibitor (PPI) treatment. The prevalence of GERD and PPI efficacy was assessed and compared among patients with different dominant symptoms. Results: Altogether 374 patients (244 with predominantly esophageal symptoms and 130 with predominantly epigastric symptoms) were enrolled. Patients with predominantly epigastric symptoms had a slightly lower prevalence of reflux esophagitis and pathological acid reflux but a significantly lower PPI response rate than those with predominantly esophageal symptoms. Multivariable logistic regression analysis revealed that the predominant symptom was independently associated with PPI efficacy but could not predict the objective existence of GERD. GERD was objectively found in 136 patients, 30% of whom complained of predominantly epigastric symptoms and had similar reflux profiles and symptom outcomes as patients with predominantly esophageal symptoms. Conclusions: Approximately 30% of patients with GERD complain of predominantly epigastric symptoms and have comparable reflux profiles and symptom outcomes as those with predominantly esophageal symptoms. Epigastric symptoms may be part of the diagnosis for GERD in a Chinese population. The study was registered with Clinicaltrials.gov (NCT02506634).

Original languageEnglish (US)
Pages (from-to)696-704
Number of pages9
JournalJournal of Digestive Diseases
Volume21
Issue number12
DOIs
StatePublished - Dec 2020

Keywords

  • acid exposure time
  • gastroesophageal reflux disease
  • proton pump inhibitors
  • reflux esophagitis
  • signs and symptoms

ASJC Scopus subject areas

  • Gastroenterology

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