Extraesophageal Symptoms Research Articles

Chinese medicine JQ granule combined with half-dose omeprazole for nonerosive reflux disease: A multicenter, randomized, double-blind, placebo-controlled trial study protocol

IntroductionNonerosive reflux disease (NERD) is a kind of esophageal disease manifesting mainly as heartburn and regurgitation. The prevalence of NERD in patients with gastroesophageal reflux disease is up to 70%, and it significantly affects the quality of life of patients. In China, besides proton-pump inhibitors (PPIs), a herbal formula is widely used in nonerosive reflux disease, which can improve intestinal and extra-intestinal symptoms of patients. This study will evaluate in a large, independent, randomized controlled trial (RCT) the comparative effectiveness of a specific type of Chinese herbal granule with half-dose PPI and full-dose PPI in managing nonerosive reflux disease. Methods and analysisThis trial will be a multicenter, randomized, double-blind, placebo-controlled RCT. A total of 204 participants will be enrolled and randomized (1:1) to each group: herb granules plus 10 mg omeprazole plus 10 mg dummy omeprazole; and dummy herb granules plus 20 mg omeprazole. The efficacy measures will be the changes in scores in the Gastroesophageal Reflux Disease Questionnaire, the Short-Form 36, the Patient Report Outcome, the 17-item Hamilton Depression Scale, and the Signs and Symptoms Scale. DiscussionThis study will focus on the quality control of a Chinese medical formulation. The RCT research procedure will be conducted under the supervision of the Good Clinical Practice (GCP) center. This trial will reduce the routine dosage of omeprazole while adding Jianpi Qinghua JQ granule, with the aim to discuss the safety and effectiveness of the Chinese herbal granule on esophageal and extraesophageal symptoms while meeting the ethical requirements.

Study of Chest Disorders in Non-Smoker Patients Complaining of Gastroesophageal Reflux Disease

AbstractBackground: Gastroesophageal reflux disease (GERD) is a common disease that is often diagnosed based on typical symptoms of heartburn and regurgitation. In addition to these more classic manifestations, GERD is increasingly associated with extra-esophageal symptoms, including chronic cough, asthma, laryngitis, and aspiration pneumonia. Management of GERD may help in management of these respiratory diseases.Aim of Study: To study the presence of chest diseases in non-smoker patients complaining of GERD.Subjects and Methods: The study was carried out on 100 patients attended to Al-Hussein and Sayed Galal Al-Azhar University Hospitals in the period from September 2017 to May 2018. Patients were categorized into two groups: Group 1: Included 100 patients complaining of heartburn, epigastric pain and respiratory symptoms confirmed to have GERD by upper GI endoscope. Group 2: Include fifty patients apparently healthy (as regard GERD symptoms) confirmed that they were not have GERD by upper GI endoscope. All patients underwent history taking, examination, routine lab investiga-tions, upper GI endoscopy, chest X-ray and spirometry. C.T. chest was done on need according to symptoms and chest X-ray finding.Results: Respiratory disorders occurrence was more in GERD group than in negative group as regard GERD with statistically significant difference between the two groups in chronic laryngitis, bronchial asthma, COPD, and pneumonia, but no significant difference between the two groups wos found as regard ILD.Conclusion: GERD is a considrable risk factor for the development of respiratory disorders. This study proved that pulmonary symptoms was elevated among those with frequent GERD compared to those without GERD.

Оптимізація діагностики респіраторних есктраезофагеальних симптомів гастроезофагеальної рефлюксної хвороби

Оптимізація діагностики респіраторних есктраезофагеальних симптомів гастроезофагеальної рефлюксної хвороби

Issues and controversies in esophageal inlet patch.

The proximal esophagus is rarely examined, and its inspection is often inadequate. Optical chromoendoscopy techniques such as narrow band imaging improve the detection rate of inlet patches in the proximal esophagus, a region in which their prevalence is likely underestimated. Various studies have reported correlations between these esophageal marks with different issues such as Barrett’s esophagus, but these findings remain controversial. Conflicting reports complicate the process of interpreting the clinical features of esophageal inlet patches and underestimate their importance. Unfortunately, the limited clinical data and statistical analyses make reaching any conclusions difficult. It is hypothesized that inlet patches are correlated with various esophageal and extraesophageal symptoms, diagnoses and the personalized therapeutic management of patients with inlet patches as well as the differential diagnosis for premalignant lesions or early cancers. Due to its potential underdiagnosis, there are no consensus guidelines for the management and follow up of inlet patches. This review focuses on questions that were raised from published literature on esophageal inlet patches in adults.

Multicenter Prospective Study of Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease in Korea.

Backgrounds/AimsThis multicenter study aims to evaluate the effect and feasibility of anti-reflux surgery compared with medical treatment for gastroesophageal reflux disease (GERD).MethodsPatients with GERD who were undergoing medical treatment with proton pump inhibitors for more than 8 weeks and those who were scheduled to undergo anti-reflux surgery were enrolled. Efficacy of pre-operative medical treatment was evaluated retrospectively and effect of anti-reflux surgery was prospectively evaluated at 1 week and 3 months after surgery. Quality of life (QOL) was also investigated before and after surgery.ResultsBetween February and October 2018, 51 patients underwent laparoscopic Nissen fundoplication for treating GERD at 5 hospitals in Korea. Thirty-four patients (66.7%) showed poor proton pump inhibitor response. At 3 months after surgery, heartburn was completely resolved in 87.9% patients and partially improved in 9.1%. Acid regurgitation was completely resolved in 82.9% and partially improved in 11.4%. Atypical extraesophageal symptoms were completely controlled in 45.5% and partially controlled in 36.4%. GERD-related QOL scores at 1 week after surgery significantly improved compared with pre-operative scores. There was no difference in GERD-related QOL scores between 1 week and 3 months after surgery. General QOL measured with European QOL-5 dimensions and health-related QOL instrument with 8 items significantly improved after anti-reflux surgery. Satisfaction with treatment was significantly higher after surgery than before surgery (72.5% vs 11.8%, P < 0.001).ConclusionAnti-reflux surgery improved GERD symptoms and QOL in patients. Anti-reflux surgery is an effective treatment option compared with medical treatment for GERD patients selected for surgical treatment.

Tu1181 – Prospective Study of a Cohort of Patients with Extraesophageal Symptoms: Can a Non-Invasive Test Predict the Results of Ph-Impedance? are Novel Mii-Ph Parameters Able to Distinguish Patients with Gerd Among Subjects with Extraesophageal Symptoms?

Tu1181 – Prospective Study of a Cohort of Patients with Extraesophageal Symptoms: Can a Non-Invasive Test Predict the Results of Ph-Impedance? are Novel Mii-Ph Parameters Able to Distinguish Patients with Gerd Among Subjects with Extraesophageal Symptoms?

Sa1207 – The Effect of a Medical Device Containing Hyaluronic Acid, Chondroitin Sulfate and Aluminum Hydroxide Combined with Acid Suppression in the Treatment of the Extraesophageal Symptoms of Gastroesophageal Reflux Disease: Preliminary Data from a Prospective, Parallel-Group Randomized Controlled Study

Sa1207 – The Effect of a Medical Device Containing Hyaluronic Acid, Chondroitin Sulfate and Aluminum Hydroxide Combined with Acid Suppression in the Treatment of the Extraesophageal Symptoms of Gastroesophageal Reflux Disease: Preliminary Data from a Prospective, Parallel-Group Randomized Controlled Study

Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan

ObjectiveGastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study...

Nutcracker upper esophageal sphincter

Background: Different manometric patterns characterize named well-defined motility disorders of the esophageal body. The detailed study of the upper esophageal sphincter (UES); however, has been neglected. It is elusive whether a similar condition as the nutcracker esophagus exists in the UES. This study aims to evaluate the prevalence and characteristics of patients with “nutcracker UES”. Methods: We retrospectively reviewed 1,000 esophageal function tests to identify patients with UES basal pressure above 190 mmHg (2 standard deviation above the average in volunteers studied in our laboratory). Demographic data and manometric parameters for the lower esophageal sphincter (LES), esophageal body and UES were recorded as well as pH monitoring variables. Results: Thirty-one patients were selected (prevalence 0.3%). There were 9 (29%) males, mean age 40±11 (range, 15–60) years. LES basal pressure was 16±15 mmHg (52% were hypotonic and 3% hypertonic). Two (6%) had a nutcracker esophagus. UES basal pressure was 235±89 mmHg. Ten (32%) had pathologic reflux with equal distribution of reflux pattern (supine vs . orthostatic). Six (19%) had extra-esophageal symptoms. Conclusions: In conclusion, nutcracker UES has a low prevalence in patients that undergo esophageal manometry. There is not a specific demographic group at risk for this manometric condition. Manometric parameters of the LES and esophageal body are not specific for this condition.

The Gastroesophageal Reflux Disease Questionnaire in Adolescents: What Is the Best Cutoff Score?

BackgroundA self-assessment questionnaire, the GERD-Questionnaire (GERD-Q) was used to determine the prevalence of GERD in adolescents, describe the related factors, and determine the impact on quality of life (QoL).MethodsThe incidence of GERD was evaluated using the GERD-Q in adolescents aged 12–18 years. The Pediatric Gastroesophageal Reflux Disease Symptom Questionnaire and Quality of Life Questionnaire (PGSQ-A) for adolescents were additionally administered. Some factors considered related to GERD were also evaluated.ResultsThe 520 adolescents were included. The prevalence of suspected GERD, according to a GERD-Q cutoff score of ≥7 was 32.9%, and those drinking soda were 1.7 times more likely to have GERD (95% confidence interval, 1.3–2.2; p<0.001). However, soda consumption was not a risk factor for development of GERD symptoms. Applying a cutoff score of ≥8, only 10.9% of the participants had a positive GERD score, but the association with soda consumption persisted. The median PGSQ-A score in subjects suspected of GERD was 8 (range 0–37) on weekends and 1 (range 0–17) during weekdays (p<0.001) compared to those not suspected of GERD, with a median of 2 (range 0–27) during weekends and 0 (range 0–10) during weekdays. Heartburn, regurgitation, and extraesophageal symptoms correlated significantly with QoL (p<0.001).ConclusionThe prevalence of suspected GERD in adolescents was 32.9% or 10.9%, depending on the cutoff score used. There was a statistically significant difference in PGSQ-A scores between the subjects suspected or not of GERD, indicating an impaired QoL.

Esophageal motility and reflux characteristics in gastroesophageal reflux disease patients with or without extra-esophageal symptoms

Objective: To investigate esophageal motility and reflux characteristics in gastroesophageal reflux disease (GERD) with and without extra-esophageal symptoms by high-resolution manometry and 24 h esophageal multichannel intraluminal impedance combined pH (MII-pH) monitoring. Methods: From February 2016 to June 2017, GERD patients with and without extra-esophageal symptoms were enrolled in this prospective controlled study. Esophageal HRM and 24 h MII-pH monitoring were performed. The differences in esophageal motility and reflux parameters were further analyzed between 30 GERD patients with extra-esophageal symptoms and 30 simple GERD patients. Results: The GERD symptom scores didn't show statistical difference between two groups. The GERD symptom scores didn't show statistical difference between two groups. The relaxation pressure of lower esophageal sphincter(LES), the integrated relaxation pressure, and the recovery time of upper esophageal sphincter(UES) of GERD patients with extra-esophageal symptoms were all lower than those of patients without extra-esophageal symptoms [(15±7) vs (21±11)mmHg, (8±3) vs (10±5)mmHg, (388±168) vs (492±170)ms, 1 mmHg=0.133 kPa], and the differences were statistically significant(all P<0.05). The main classification of esophageal motility type of GERD patients with extra-esophageal symptoms was mild esophageal motility disorders (27%, 8/30), and the occurrence of ineffective esophageal motivation was 20% (6/30), which were similar with simple GERD patients. The proximal reflux percentages of weak acid reflux and nonacid reflux, abnormal nonacid reflux in GERD patients with extra-esophageal symptoms were significantly higher than those in simple GERD patients [84.6% (73.2%, 100.0%) vs 75.0% (60.0%, 87.65%), P=0.048; 90.0% (45.8%, 100.0%) vs 0(0, 100.0%), P=0.017; 46.7% vs 3.3%, P=0.03]. Conclusions: The pathogenesis of GERD with extra-esophageal symptoms may be different from typical GERD. Increase of proximal esophageal reflux and abnormal nonacid reflux may all participate in the mechanisms of GERD with extra-esophageal symptoms.

Covering the Cover

Covering the Cover

Electrical neuromodulation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a difficult to treat medical condition. Inadequate symptom control has been cited as one of the main reasons to drive to surgical therapies for GERD. This unmet medical need has led to new attempts at developing less-invasive therapies for the treatment of GERD. Lower esophageal sphincter (LES) electrical neuromodulation has been shown to improve outcomes in GERD, and may represent and alternative of treatment for special subgroups of patients, such as esophageal dysmotility patients, sleeve gastrectomy and lung transplant patients. A concise review of literature was performed through PubMed. We searched to identify published studies reporting on subjective and objective GERD after LES-electrical neuromodulation therapy (ENT). Data evaluated included GERD-health-related quality of life (HRQL), extra esophageal symptoms, PPI discontinuation and patient satisfaction rates, pH-study metrics, severe adverse effects (AEs), and treatment failures. The aim of the review is to summarize the safety and efficacy of LES-ENT in GERD patients reported up to date, including original data from the authors. Two clinical trials have shown safety and efficacy of LES-ENT with both short and long-term follow-up up to 3 years. Results were comparable in a prospective multi-center registry of LES-ENT for GERD with 223 patients from 16 sites in Europe and Latin America with an extended 5-year-follow up. LES-ENT has shown adequate efficacy in symptom control, medication use, acid exposure control, a solid safety profile and may represent an alternative treatment for patients that are not satisfied with PPI therapy, unable to receive a fundoplication or reluctant to undergo reported side effects. LES-ENT allows correction of hiatal hernia when needed, enhancing the effects of neuromodulation that can also be optimized after surgery. This can lead to an expanded indication of surgical therapies for those patients with unmet needs for GERD.

Benchmarking of a Simple Scintigraphic Test for Gastro-oesophageal Reflux Disease That Assesses Oesophageal Disease and Its Pulmonary Complications

Objectives:Gastro-oesophageal reflux disease (GORD) is both common and troubling with a prevalence of 20-40%. We assessed the utility of a scintigraphic reflux study to evaluate the oesophageal and extra-oesophageal manifestation of disease compared to the standard tests such as pH monitoring and manometry.Methods:Patients were recruited into a prospective database of referrals to a tertiary referral center for either resistance to maximal medical therapy or extra-oesophageal symptoms of GORD. Data included 2 channel 24-hour pH monitoring and manometry results, as well as scintigraphic reflux data with late images assessing pulmonary aspiration of refluxate.Results:Study population included 250 patients (155 F, 95 M) with an average age of 60 years. Patients were clinically classified as either GORD (n=72) or laryngopharyngeal reflux (LPR) (n=178). Pulmonary aspiration of the refluxate was detected significantly more commonly in LPR patients (58/178 compared with GORD 10/72). Strong correlations were found between the scintigraphic time-activity curves in the upper oesophagus and pharynx, and ineffective oesophageal motility and pulmonary aspiration. pH studies correlated with the scintigraphic studies but did not predict aspiration similar to other modalities when evaluated by ROC analysis.Conclusion:Scintigraphic reflux studies offer a viable alternative test for GORD and extra-oesophageal manifestations of reflux disease. Strong correlations were found between measurable scintigraphic parameters and oesophageal motility and lung aspiration of refluxate. This may provide a more confident decision analysis in patients being considered for fundoplication for troubling extra-oesophageal symptoms.

Extraesophageal (EER) Symptoms Are Associated With Fewer Acid Related Reflux Episodes as Compared to Typical Gastroesophageal Reflex (GER) Symptoms

Extraesophageal (EER) Symptoms Are Associated With Fewer Acid Related Reflux Episodes as Compared to Typical Gastroesophageal Reflex (GER) Symptoms

Elevated Tryptase in EoE Is an Independent Phenomenon Associated with Extra-Esophageal Symptoms.

Eosinophilic esophagitis (EoE) is a chronic disease characterized histologically by > 15 eosinophilsper high-power field (eos/hpf). Esophageal mucosal mast cells have been implicated in EoE pathogenesis. The association of atopy with EoE has been established but has not been correlated with levels of serum tryptase. The lack of concurrent atopy in some patients suggests the possibility that atopy may either be the related subtype of EoE or may be a sign of comorbidities. No study has looked at whether patients present with different phenotypes/comorbid disease when they have evidence of elevated serum tryptase. We hypothesized that these patients differ with respect to presentation and comorbidities with more refractory GI disease. To examine whether elevations of serum tryptase associate with different, more severe clinical presentations in EoE patients which may be explained via mast cell activation. Retrospective chart review identified 72 patients with EoE with results for serum tryptase between 2015 and 2016. Patients were classified as TryptaseHI (tryptase > 10.9µg/l) and TryptaseLO (< 10.9µg/l). Clinical characteristics and treatment response were compared using univariate analysis and multivariate regression between the groups. Out of 72 patients, 12 were tested as TryptaseHI (16.7%, 95% CI 8.1-25.3%). TryptaseHI was associated frequently with asthma (P = 0.0003), urticaria (P = 0.002), arthralgia (P = 0.005), sinusitis (P = 0.03), nausea/vomiting (P = 0.046), and eosinophilic gastrointestinal disease (P = 0.001). Asthma and arthralgia were found to be significantly associated with TryptaseHI (P = 0.0013, P = 0.0098, respectively). Mucosal eosinophil counts and tryptase levels were not correlated (R2 0.095, P = 0.77). Tryptase did not resolve with resolution of esophageal eosinophilia. We found that EoE patients with elevated tryptase levels more commonly presented with asthma, urticaria, arthralgia, nausea/vomiting, sinusitis, and more distal eosinophilia. This indicates that atopy in EoE patients warrants further exploration. The lack of correlation between histologic remission and reduction of serum tryptase levels post-treatment suggests that mast cell activation may be an independent, yet associated disease. More study into this unique association is warranted.

Respiratory symptoms associated with eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is an atopic condition diagnosed based on eosinophilic infiltration in the esophagus and symptoms of esophageal dysfunction. Typical clinical manifestations of EoE include feeding refusal, vomiting, and dysphagia however recent reports highlight an associations with extraesophageal symptoms. By definition the inflammatory response in EoE is restricted to the esophagus. However, accounts of symptoms such as chronic refractory cough, recurrent croup, hoarseness as well as subglottic stenosis, and an increase in otolaryngologic surgeries in patients with EoE raise the possibility of extraesophageal manifestations of the disease. These symptoms have been reported at times in the absence of typical gastrointestinal symptoms. While the condition is usually managed by gastroenterologist and/or allergist, the presence of extraesophageal symptoms and comorbid conditions may result in patients presenting initially to providers in other subspecialties such as pulmonology and otorhinolaryngology. The use of proton pump inhibitors and corticosteroids are part of the management of EoE. Awareness of the possibility of EoE before the empiric use of these therapies is important as there use can make identifying and diagnosing patients with EoE correctly challenging. We review the medical literature regarding extraesophageal manifestations of EoE and highlight the importance of awareness for subspecialist outside of gastroenterology and allergy for the condition.

PS01.059: REFLUX RELATED SYMPTOMS ARE LESS COMMON IN SOUTH-EAST HUNGARIAN SUBJECTS, THAN EXPECTED ON THE BASIS OF EPIDEMIOLOGIC STUDIES OF THE WESTERN COUNTRIES

Abstract Background Most population based epidemiologic studies indicate approximately 20% prevalence of Gastroesophageal Reflux (GER) related typical symptoms appearing at least monthly. Since most of these works were carried out in the western countries, a little is known about Central-Europe, where substantial part of the population still lives outside of the larger cities. The aim of the study was to obtain population-based data on the prevalence of GER related symptoms in South-East Hungary. Methods Two thousand and two consecutive blood donor volunteers (M/F: 1156/846, mean age: 39 (17–66) years) were enrolled. Data collection was carried out by means of a questionnaire. Typical (heartburn, regurgitation) and atypical (esophageal, extraesophageal) symptoms were assessed. Results Typical symptoms of GER such as heartburn and acidic regurgitation were reported by 22% (450/2002) and 17% (333/2002) of the studied healthy subjects. The 63% and 51% of them had such symptoms less than once per month. Monthly heartburn episodes were reported by 14, and weekly by 6 percent of the cases, while acidic regurgitation occurred in 8 and 3 percent respectively. Of the atypical (esophageal and extraesophageal) symptoms upper airway symptoms were the most prevalent (19%), although only 13% had such symptom at least monthly. Globus occurred in 6%, while other atypical symptoms were reported by less than 5% of the subjects. Typical GER symptoms occurred more frequently in females, coffee drinkers and subjects with moderate obesity. Current and former smoking and alcohol-use were associated with increased GER symptom prevalence. Conclusion In contrast to the studies carried out in the western countries South-East Hungarian subjects seem to have less GER related symptoms. Disclosure All authors have declared no conflicts of interest.

Model to Select On-Therapy vs Off-Therapy Tests for Patients With Refractory Esophageal or Extraesophageal Symptoms

It is not clear whether we should test for reflux in patients with refractory heartburn or extraesophageal reflux (EER) symptoms, such as cough, hoarseness, or asthma. Guidelines recommend testing patients by pH monitoring when they are on or off acid-suppressive therapies based on pretest probability of reflux, determined by expert consensus. However, it is not clear what constitutes a low or high pretest probability of reflux in these patients. We aimed to develop a model that clinicians can use at bedside to estimate pretest probability of abnormal reflux. We performed a prospective study of 471 adult patients with refractory heartburn (n= 214) or suspected EER symptoms (n= 257) who underwent endoscopy with wireless pH monitoring while they were off acid-suppressive treatment and assigned them to groups based on symptoms at presentation (discovery cohort). Using data from the discovery cohort, we performed proportional odds ordinal logistic regression to select factors (easy to obtain demographic criteria and clinical symptoms such as heartburn, regurgitation, asthma, cough, and hoarseness) associated with esophageal exposure to acid. We validated our findings in a cohort of 118 patients with the same features from 2 separate tertiary care centers (62% women; median age 59 years; 62% with cough as presenting symptom). Abnormal pH (>5.5% of time spent at pH <4) was found in 56% of patients with heartburn and 63% of patients with EER (P= .15). Within EER groups, abnormal pH was detected in a significantly larger proportion (80%) of patients with asthma compared with patients with cough (60%) or hoarseness (51%; P < .01). Factors significantly associated with abnormal pH in patients with heartburn were presence of hiatal hernia and body mass index >25 kg/m2. In patients with EER, the risk of reflux was independently associated with the presence of concomitant heartburn (odds ratio [OR] 2.0; 95% confidence interval [CI] 1.3-3.1), body mass index >25 kg/m2 (OR 2.1; 95% CI 1.5-3.1), asthma (OR 2.0; 95% CI 1.2-3.5), and presence of hiatal hernia (OR 1.9; 95% CI 1.2-3.1). When we used these factors to create a scoring system, we found that a score of ≤2 excluded patients with moderate to severe reflux, with a negative predictive value of 80% in the discovery cohort and a negative predictive value of 85% in the validation cohort. We developed a clinical model to estimate pretest probability of abnormal pH in patients who were failed byproton pump inhibitor therapy. This system can help guide clinicians at bedside in determining the most appropriate diagnostic test in this challenging group of patients.

A comparison of clinical characteristics between reflux esophagitis and non-erosive reflux disease

Objective To analyze and compare the demographic characteristics and clinical features of patients with reflux esophagitis (RE) and non-erosive reflux disease (NERD), so as to appraise their different pathogenesis and effective treatment. Methods 127 patients with RE and 80 patients with NERD were enrolled and asked to complete the questionnaires. The general situation, living habits, typical esophageal symptoms, extra esophageal symptoms and the comorbidities were recorded in the two groups. Results There were more male patients in RE group, and more female patients in NERD group (P<0.05). There were more patients engaged in mental work in RE group , and NERD group had more physical workers (P<0.05). Compared with NERD, patients with RE were fatter and had more alcohol consumption (P<0.05). The proportion of patients with abnormal mental disorders in NERD group was significantly higher than that in RE group (P<0.05). NERD patients were more likely to incorporate irritable bowel syndrome (IBS) (P<0.05). RE patients were more likely to suffer from hiatal hernia (P<0.05). The incidence of anti-acid, chest pain, pharyngeal foreign body symptoms was higher in the NERD group (P<0.05). Conclusions The demographic characteristics, living habits, mental and psychological factors, esophageal symptoms, extra esophageal symptoms and comorbidities in patients with NERD or RE are different.These results suggest that there are different pathogenesis between RE and NERD . Key words: Esophagitis, peptic; Gastroesophageal reflux; Disease attributes