Association Between Proximal Histological Esophagitis and Atypical Reflux Symptoms in Patients with GERD

Abstract

Purpose: Globus sensation, chest pain, chronic cough are suggested as atypical or extraesophageal manifestations for gastroesophageal reflux disease (GERD). Increased proximal esophageal acid reflux is observed in reflux patients with extraesophageal symptoms. Although histological abnormalities have been described in patients with GERD, the association between proximal esophageal inflammation and atypical reflux symptoms remains unclear. The aim of this study was to investigate the prevalence of atypical symptoms and histological reflux esophagitis (HRE) in patients with GERD. We also addressed the question of whether proximal HRE correlated with these atypical symptoms. Methods: The study involved 92 prospective patients (55 women, age 46, 20-82 yr) with typical symptoms (heartburn and/or regurgitation) suggestive of GERD. Endoscopical evidence of erosive esophagitis was diagnosed according to Los Angeles classification. Endoscopic biopsies were taken 3 cm and 13 cm above the gastroesophageal junction to assess the presence of HRE. Results: Of all GERD patients, there were 28 patients with globus sensation (30.4%), 45 patients with chest pain (48.9%), 32 patients with chronic cough (34.8%). Forty-seven patients were found to have normal endoscopy (NE) (51.1%), and 45 patients with erosive esophagitis (EE) (48.9%). HRE was detected in 48 patients (52.2%) for distal esophagus, whereas 42 patients (45.7%) had proximal histological esophagitis. Distal HRE occurred 23 of 45 patients with EE (51.1%) and 25 of 47 patients with NE (53.2%) (p=NS), while proximal HRE occurred in 19 of 45 patients with EE (42.2%) and 23 of 47 patients with NE (48.9%) (p=NS). No statistical difference was found regarding the prevalence of any atypical symptom between EE and NE patients. Proximal HRE did not correlate well with the presence of any atypical symptom. Conclusion: Atypical reflux symptoms appear to be equally present in patients with and without erosive esophagitis. Histological reflux esophagitis can be detected in both proximal and distal esophagus regardless of the presence of erosive esophagitis as noticed by endoscopy. None of atypical reflux symptoms correlates with proximal histological reflux esophagitis, suggesting that proximal esophageal inflammation may play a limited role, if any, in the generation of these symptoms.