Esophageal sensitivity and symptom perception in gastroesophageal reflux disease

Abstract

Patients with gastroesophageal reflux disease (GERD) experience a wide spectrum of symptoms, varying both in quality and severity. This review summarizes clinical observations of esophageal sensitivity and symptom perception in GERD patients. The Bernstein test, although lacking standardization, remains a useful tool in determining esophageal sensitivity to acid stimuli. Ambulatory 24-hour pH monitoring with symptom event marking and subsequent symptom-reflux correlation between acid reflux events and esophageal symptomatology now provides an alternative method for establishing esophageal acid sensitivity. The intraesophageal balloon distention test (IEBD) was developed to assess esophageal sensitivity to mechanical stimuli. Variants of each of these tests have been applied to the evaluation of uncomplicated GERD patients and patients with esophagitis and Barrett's metaplasia, who generally demonstrate less esophageal sensitivity than the former group. Studies using these methods have demonstrated increased esophageal sensitivity in patients with esophageal chest pain and have also identified a subset of patients with esophageal symptoms yet normal esophageal acid exposure, a condition referred to as "hypersensitive esophagus." The Bernstein test, 24-hour pH monitoring with symptom assessment, and IEBD have each contributed to our understanding of esophageal pain syndromes; it is hoped that future work in this area will lead to improved and more specific therapy for these patients.

Does major depression in patients with gastroesophageal reflux disease affect the outcome of laparoscopic antireflux surgery?

“…There should be no question that an objective assessment such as a pH study or endoscopy after antireflux surgery is recommended to document surgical outcome. It is known that physiologic data such as endoscopically confirmed esophagitis, esophageal body peristalsis, lower esophageal sphincter pressure, and findings in 24-h pH monitoring do not correlate well with patients' perception of symptom severity and quality-of-life data [13,16].…”

“…This validated index, used in several previous studies and [7,16,19] recommended by the European Study Group for Antireflux Surgery [5], finally is available in English and French versions [3,17]. The grading of GIQLI ranges from 0 to 144 points, with healthy individuals having a mean of 122.6 points, which can be divided into five different subscores for the following: gastrointestinal symptoms (0-76 points), emotional status (0-20 points), physical functions (0-28 points), social functions (0-16 points), and stress of medical treatment (a single item valued at 0-4 points).…”

Patient-reported outcomes. How important are they?

“…If after sugery the symptoms are abolished or become less severe, the treatment was successful from the patientsÕ perspective [33,26]. Several studies have documented that there is no correlation between the severity of symptoms and the severity of the disease, and particularly in GERD, no correlation has been reported between the objective measures of refluxinduced damage and presenting symptoms [2,31,37,40].…”

Tests for the Evaluation of Functional Gastrointestinal Disorders

“…However, it has been suggested to be useful in evaluating patients with non-GERD-related NCCP and functional heartburn [18][19][20].…”