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

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).

Asia‐Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms

“…In those reporting epigastric burning, acid reflux was present in as many as 50%, and this symptom best predicted response to PPI treatment 9 . On the other hand, in other studies from China, epigastric pain or burning was present in 12–20% of patients with GERD, and in these patients, their reflux profiles and symptom outcomes were comparable with GERD patients with predominantly esophageal symptoms 10,11 …”

“…9 On the other hand, in other studies from China, epigastric pain or burning was present in 12-20% of patients with GERD, and in these patients, their reflux profiles and symptom outcomes were comparable with GERD patients with predominantly esophageal symptoms. 10,11 Pathophysiology Impaired gastric accommodation with transient lower esophageal sphincter relaxations (TLESRs). Impaired gastric accommodation is known to be associated with satiation in FD.…”