Gastroesophageal reflux disease (GERD): Many faces of one disease

Abstract

Gastroesophageal reflux disease (GERD) is a pathological condition or disease, caused by returning the gastric and duodenal content through incompetent gastroesophageal junction into the esophagus. Heartburn and regurgitation are the most common and most characteristic typical symptoms of GERD. But there is a whole range of atypical symptoms of GERD that we have to think of, because at first glance they do not seem to be the result of reflux. The aim of this study is to highlight the importance of atypical (extraesophageal) symptoms of GERD and determine the correlation between atypical symptoms in patients with reflux disease and its endoscopic findings. Patients were selected by a random sampling method in order of reporting on endoscopic examination. The main criterion was to have the cardinal symptoms of GERD: heartburn and regurgitation. Endoscopic classification of the existing changes in the esophagus was based on the Los Angeles Classification of endoscopic GERD. During endoscopy at least two biopsies were taken to determine the Helicobacter pylori status. A sample of 88 subjects was divided into three subsamples according to the degree of reflux disease. The statistical analyses used were multivariate methods, MANOVA and discriminant analysis. Roy's test was applied as a univariante method. A statistically significant correlation between the degree of severity of reflux disease and symptoms was found: regurgitation, dry cough, globe syndrome, non-cardiac chest pain. There was no correlation between the severity of symptoms and the extent of damage of the esophagus lining. In patients with atypical symptoms, low levels of mucosal damage were found by endoscopy. Heartburn as a cardinal symptom of GERD is manifested in the majority of subjects but there was a lack of association between the severity of GERD and symptoms of heartburn. It was concluded that patients with atypical symptoms of GERD did not have or did not have to complain of heartburn. Patients differed from each other by ENT atypical manifestations of reflux disease, meaning that this symptomatology is the most distinctive atypical manifestation of GERD. Patient and thorough anamnesis is a key first step in the diagnosis of patients with atypical manifestations of GERD. In order to complete the diagnosis and decide on adequate treatment, patients with atypical manifestations of GERD need to undergo pH and esophageal manometry.