World journal of gastrointestinal endoscopy · 2026
Upper gastrointestinal endoscopy in patients with gastroesophageal reflux disease symptoms: Correlating endoscopic findings with symptoms and pH-impedance results.
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Wickramasinghe Nilanka, Devanarayana Niranga Manjuri
Аннотация
BACKGROUND: Gastroesophageal reflux disease (GERD) is often diagnosed symptomatically. However, objective assessments such as upper gastrointestinal endoscopy (UGIE) and multichannel intraluminal impedance-pH (MII-pH) testing are essential for accurate diagnosis. The correlation between symptoms and objective findings remains uncertain.
AIM: To evaluate UGIE findings in patients with GERD symptoms and correlate them with symptom profiles and MII-pH results.
METHODS: An observational study was conducted in 209 patients (mean age: 45.8 ± 15.2 years; 46.1% males), attending the National Hospital of Sri Lanka with GERD symptoms. Data was collected using interviewer-administered questionnaires and clinical records. UGIE, high-resolution manometry, and MII-pH tests were conducted as indicated by the consultant gastroenterologist.
RESULTS: UGIE was performed in 95% of patients, but only 33% had objective evidence of reflux (30% esophagitis, 3% Barrett's esophagus). Hiatal hernia and gastritis were identified in 52% and 70%, respectively. MII-pH testing was done in 23% of patients. Of the 23%, one in four showed acid exposure times (AET) > 4%. Patients with non-erosive reflux disease had significantly elevated mean AET and lower mean nocturnal baseline impedance than those with erosive disease. Among those with AET > 4% (n = 13), 7 had gastritis; however, AET was significantly higher in those without gastritis. Eight patients with normal AET and high symptom scores had esophagitis on endoscopy.
CONCLUSION: Most patients with GERD symptoms lacked objective evidence of reflux in both endoscopy and MII-pH monitoring, indicating the limitations of symptom-based diagnosis of GERD. Broader access to diagnostic facilities is essential for exact diagnosis, optimum management, and prevention of complications of GERD.
AIM: To evaluate UGIE findings in patients with GERD symptoms and correlate them with symptom profiles and MII-pH results.
METHODS: An observational study was conducted in 209 patients (mean age: 45.8 ± 15.2 years; 46.1% males), attending the National Hospital of Sri Lanka with GERD symptoms. Data was collected using interviewer-administered questionnaires and clinical records. UGIE, high-resolution manometry, and MII-pH tests were conducted as indicated by the consultant gastroenterologist.
RESULTS: UGIE was performed in 95% of patients, but only 33% had objective evidence of reflux (30% esophagitis, 3% Barrett's esophagus). Hiatal hernia and gastritis were identified in 52% and 70%, respectively. MII-pH testing was done in 23% of patients. Of the 23%, one in four showed acid exposure times (AET) > 4%. Patients with non-erosive reflux disease had significantly elevated mean AET and lower mean nocturnal baseline impedance than those with erosive disease. Among those with AET > 4% (n = 13), 7 had gastritis; however, AET was significantly higher in those without gastritis. Eight patients with normal AET and high symptom scores had esophagitis on endoscopy.
CONCLUSION: Most patients with GERD symptoms lacked objective evidence of reflux in both endoscopy and MII-pH monitoring, indicating the limitations of symptom-based diagnosis of GERD. Broader access to diagnostic facilities is essential for exact diagnosis, optimum management, and prevention of complications of GERD.