Significance and Degree of Reflux in Patients With Primary Extraesophageal Symptoms

Objectives/Hypothesis: Patients with extraesophageal symptoms are often suspected of having gastroesophageal reflux disease (GERD). However, the true prevalence and severity of reflux disease is not well studied. In this group of patients, the objectives of our study were to determine the prevalence and severity of esophageal acid exposure and classify the endoscopic findings. Study Design: Prospective cohort study. Methods: One hundred twenty-eight patients with extraesophageal symptoms underwent 48 hours of Bravo pH monitoring. Percent of time that pH was <4 (total upright and supine) was measured. Severity of reflux was categorized by the percent of total time pH was <4, with mild = >4.2% but <10%, moderate = 10% to 20%, and severe>20%. Endoscopic signs of esophagitis and Barrett's esophagus were determined. Results: There were 104/128 (81%) patients who had abnormal esophageal acid exposure, 44% in the upright and supine position, 38% in the upright position only, and 18% in the supine position only. There were 59/128 (46%) patients with mild reflux, 40/128 (31%) with moderate, and only 5/128 (4%) patients with severe reflux. 23/128 (18%) patients had evidence of esophagitis. Only 1/128 (0.8%) patients had pathologic Barrett's esophagus. Prevalence of abnormal esophageal acid exposure was similar in those with (75%) or without (66%) concomitant heartburn and/or regurgitation (P = .3). Conclusions: Abnormal esophageal pH is common in patients with extraesophageal symptoms. Most have only mild (46%) to moderate (31%) reflux with a low prevalence of esophagitis (18%) or Barrett's esophagus (0.8%). The degree of esophageal acid reflux cannot be predicted from baseline presence or absence of typical GERD symptoms.