Characteristics of Patients with Reflux Esophagitis, Non-Erosive Reflux Disease and Functional Heartburn

Abstract

Purpose: Patients with non-erosive reflux disease (NERD) account for up to 70% of the gastroesophageal reflux disease (GERD) population and represent a heterogenous group. Our aim was to compare the demographics and clinical characteristics of patients with reflux esophagitis (RE), NERD, and functional heartburn (FH). Methods: We reviewed the medical records of 81 consecutive patients with frequent heartburn and regurgitation on whom Bravo™ capsule 48-h esophageal pH monitoring was performed after capsule placement under endoscopic guidance. Patients were instructed to stop taking acid-suppressive therapy at least 7 days before the pH study. An abnormal study was defined as either a DeMeester score ≥ 14.72 or a mean acid exposure time (the percentage of time pH less than 4) ≥ 4.5%. Patients with esophageal mucosal injury observed during capsule placement or during a prior endoscopy comprised the RE group. The remaining patients were divided into two groups according to pH monitoring study results: NERD (those with an abnormal pH study) and functional heartburn (FH) (those with a normal pH study). Chi-square and t-test were used to compare categorical and continuous data between groups. Results: Of 81 patients, 28 (35%) were in the RE group, 27 (51%) comprised the NERD group and 26 (49%) met our criteria for the FH group. No statistically significant difference was found between the three groups in distribution with respect to age, prevalence of hiatal hernia, and presenting symptoms, except that patients with RE had more respiratory symptoms (cough, hoarseness, shortness of breath) compared to patients with NERD or FH (See Table), and patients with FH were more likely to be female. Interestingly, only 16 of 28 RE patients had an abnormal pH study. Conclusion: Patients with RE experience more respiratory symptoms compared to patients with NERD or FH. As only 57% of RE patients had an abnormal pH study, factors other than acid exposure may contribute to the development of esophagitis. FH is more common in women than men.Table