Wickramasinghe N, Devanarayana NM. Upper gastrointestinal endoscopy in patients with gastroesophageal reflux disease symptoms: Correlating endoscopic findings with symptoms and pH-impedance results. World J Gastrointest Endosc 2026; 18(1): 111395 [DOI: 10.4253/wjge.v18.i1.111395]
Corresponding Author of This Article
Niranga Manjuri Devanarayana, MD, PhD, Professor, Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Western Province, Sri Lanka. niranga@kln.ac.lk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jan 16, 2026; 18(1): 111395 Published online Jan 16, 2026. doi: 10.4253/wjge.v18.i1.111395
Upper gastrointestinal endoscopy in patients with gastroesophageal reflux disease symptoms: Correlating endoscopic findings with symptoms and pH-impedance results
Nilanka Wickramasinghe, Department of Physiology, Faculty of Medicine, University of Colombo, Colombo 00800, Western Province, Sri Lanka
Niranga Manjuri Devanarayana, Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama 11010, Western Province, Sri Lanka
Author contributions: Wickramasinghe N and Devanarayana NM carried out the research, wrote the main manuscript text, and prepared figures and tables. All authors approve the final manuscript.
Supported by the University Grants Commission, No. UGC/VC/DRIC/PG2019(1)/CMB/01.
Institutional review board statement: Ethical clearance was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Colombo, approval No. EC-19-091.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated during or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Niranga Manjuri Devanarayana, MD, PhD, Professor, Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Western Province, Sri Lanka. niranga@kln.ac.lk
Received: July 1, 2025 Revised: August 7, 2025 Accepted: October 31, 2025 Published online: January 16, 2026 Processing time: 200 Days and 15.8 Hours
Abstract
BACKGROUND
Gastroesophageal reflux disease (GERD) is often diagnosed symptomatically. However, objective assessments such as upper gastrointestinal endoscopy (UGIE) and multichannel intraluminal impedance-pH (MII-pH) testing are essential for accurate diagnosis. The correlation between symptoms and objective findings remains uncertain.
AIM
To evaluate UGIE findings in patients with GERD symptoms and correlate them with symptom profiles and MII-pH results.
METHODS
An observational study was conducted in 209 patients (mean age: 45.8 ± 15.2 years; 46.1% males), attending the National Hospital of Sri Lanka with GERD symptoms. Data was collected using interviewer-administered questionnaires and clinical records. UGIE, high-resolution manometry, and MII-pH tests were conducted as indicated by the consultant gastroenterologist.
RESULTS
UGIE was performed in 95% of patients, but only 33% had objective evidence of reflux (30% esophagitis, 3% Barrett’s esophagus). Hiatal hernia and gastritis were identified in 52% and 70%, respectively. MII-pH testing was done in 23% of patients. Of the 23%, one in four showed acid exposure times (AET) > 4%. Patients with non-erosive reflux disease had significantly elevated mean AET and lower mean nocturnal baseline impedance than those with erosive disease. Among those with AET > 4% (n = 13), 7 had gastritis; however, AET was significantly higher in those without gastritis. Eight patients with normal AET and high symptom scores had esophagitis on endoscopy.
CONCLUSION
Most patients with GERD symptoms lacked objective evidence of reflux in both endoscopy and MII-pH monitoring, indicating the limitations of symptom-based diagnosis of GERD. Broader access to diagnostic facilities is essential for exact diagnosis, optimum management, and prevention of complications of GERD.
Core Tip: A significant proportion of patients with gastroesophageal reflux disease (GERD) symptoms lack objective evidence of reflux on endoscopy or pH impedance testing. It highlights the need for objective diagnostic tools in evaluating GERD, in addition to symptom-based diagnosis. Future directions should include increasing the availability of endoscopy and pH impedance testing facilities, training of specialists to improve reporting standards, reducing the cost of diagnostic tests, and developing population-specific guidelines and standards. Enhancing diagnostic precision will not only improve patient outcomes and resource utilization in GERD management, but also recognition and appropriate treatment of functional heartburn and reflux hypersensitivity.
