Upper gastrointestinal endoscopy in patients with gastroesophageal reflux disease symptoms: Correlating endoscopic findings with symptoms and pH-impedance results.

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.