Upper Endoscopy in Patients with Extra-Oesophageal Reflux Symptoms: A Multicentre Study
Angelo Zullo, Giulia Fiorini, Gabrio Bassotti, Francesco Bachetti, Fabio Monica, Daniele Macor, Omero Alessandro Paoluzi, Giuseppe Scaccianoce, Piero Portincasa, Vincenzo De Francesco, Roberto Lorenzetti, Ilaria Maria Saracino, Matteo Pavoni, Dino Vaira, Angelo Zullo, Giulia Fiorini, Gabrio Bassotti, Francesco Bachetti, Fabio Monica, Daniele Macor, Omero Alessandro Paoluzi, Giuseppe Scaccianoce, Piero Portincasa, Vincenzo De Francesco, Roberto Lorenzetti, Ilaria Maria Saracino, Matteo Pavoni, Dino Vaira
Abstract
Background: There are no evidence-based recommendations for performing upper gastrointestinal endoscopy (UGIE) in patients with extra-oesophageal symptoms of gastro-oesophageal reflux disease (GORD). However, UGIEs are often performed in clinical practice in these patients. We aimed to assess the prevalence of gastro-oesophageal lesions in patients with atypical GORD symptoms.
Methods: Patients complaining of at least one extra-oesophageal GORD symptom and undergoing UGIE in seven centres were prospectively enrolled. Clinically relevant lesions (Barrett's oesophagus, erosive oesophagitis, gastric precancerous conditions, peptic ulcer, cancer, and H. pylori infection) were statistically compared between groups regarding GORD symptoms (atypical vs. both typical and atypical), type of atypical symptoms, age, and presence of hiatal hernia.
Results: Two hundred eleven patients were enrolled (male/female: 74/137; mean age: 55.5 ± 14.7 years). Barrett's oesophagus was detected in 4 (1.9%), erosive oesophagitis in 12 (5.7%), gastric precancerous conditions in 22 (10.4%), and H. pylori infection in 38 (18%) patients. Prevalence of clinically relevant lesions was lower in patients with only atypical GORD symptoms (28.6 vs. 42.5%; p = 0.046; χ2 test), in patients ≤50 years (20 vs. 44.8%; p = 0.004; χ2 test), and in those in ongoing proton pump inhibitor (PPI) therapy (21.1 vs. 40.2%; p = 0.01; χ2 test). No clinically relevant lesions were detected in patients ≤50 years, without alarm symptoms, and receiving PPI therapy. Hiatal hernia was diagnosed in only 6 patients with cardiologic and in 41 patients with ear-nose-throat symptoms (11.3 vs. 35.1%; p = 0.03; χ2 test).
Conclusions: Clinically relevant lesions are uncommon among young (≤50 years) patients with extra-oesophageal GORD symptoms. Hiatal hernia is not more prevalent in patients with cardiologic symptoms and suspicion of GORD. The usefulness of UGIE in these patients is questionable.
Keywords: Diagnostic yield; Extra-oesophageal reflux; Gastro-oesophageal reflux; Upper gastrointestinal endoscopy.
Conflict of interest statement
The authors have no conflicts of interest to declare.
Copyright © 2020 by S. Karger AG, Basel.
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Source: PubMed