Symptom Characteristics and Psychosomatic Profiles in Different Spectrum of Gastroesophageal Reflux Disease
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Background/Aims: Gastroesophageal reflux disease(GERD) is diagnosed based on symptoms of heartburn andregurgitation but is a heterogeneous condition which can besubclassified according to endoscopy and esophageal refluxmonitoring. The aim of this study was to identify differencesin demographic characteristics and reflux symptom patternsamong patients with various spectrum of GERD. Methods:Patients having weekly heartburn or acid regurgitation wereclassified into four pathophysiological subgroups accordingto endoscopy and pH monitoring: reflux esophagitis (RE),endoscopy-negative reflux disease with pathological reflux(PR+), hypersensitive esophagus (HE), and normal acid exposurewith negative symptom association (pH-). Results: Atotal of 195 patients were enrolled. The numbers of patientsin the subgroups were: RE, 39.0%; PR+, 20.0%; HE, 10.3%;and pH-, 30.8%. Grossly, reflux symptom patterns and relieving/exacerbating factors did not differ between subgroups. Prevalence of extraesophageal syndrome was higher in patientswith PR+ than in other groups. Overlapping functionaldyspepsia was common in all groups. The SCL-90-R depressionscore was higher in PR+ patients than in RE patients(p<0.05). Conclusions: Demographic characteristics andreflux symptom patterns cannot differentiate pH- group fromGERD subtypes. Esophageal pH monitoring could be consideredfor the initial evaluation of GERD in the tertiary referralsetting.
Abstract
Background/Aims: Gastroesophageal reflux disease(GERD) is diagnosed based on symptoms of heartburn andregurgitation but is a heterogeneous condition which can besubclassified according to endoscopy and esophageal refluxmonitoring. The aim of this study was to identify differencesin demographic characteristics and reflux symptom patternsamong patients with various spectrum of GERD. Methods:Patients having weekly heartburn or acid regurgitation wereclassified into four pathophysiological subgroups accordingto endoscopy and pH monitoring: reflux esophagitis (RE),endoscopy-negative reflux disease with pathological reflux(PR+), hypersensitive esophagus (HE), and normal acid exposurewith negative symptom association (pH-). Results: Atotal of 195 patients were enrolled. The numbers of patientsin the subgroups were: RE, 39.0%; PR+, 20.0%; HE, 10.3%;and pH-, 30.8%. Grossly, reflux symptom patterns and relieving/exacerbating factors did not differ between subgroups. Prevalence of extraesophageal syndrome was higher in patientswith PR+ than in other groups. Overlapping functionaldyspepsia was common in all groups. The SCL-90-R depressionscore was higher in PR+ patients than in RE patients(p<0.05). Conclusions: Demographic characteristics andreflux symptom patterns cannot differentiate pH- group fromGERD subtypes. Esophageal pH monitoring could be consideredfor the initial evaluation of GERD in the tertiary referralsetting.
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