Upper gastrointestinal endoscopy in patients with gastroesophageal reflux disease symptoms: Correlating endoscopic findings with symptoms and pH-impedance results

Table 1 Comparison of pH impedance parameters between different patient categories, mean ± SD, 95% confidence interval

Metrics per 24 hours	ERD (n = 13)	NERD (n = 8)	RH (n = 8)	FH (n = 6)	ERD with AET > 4% (n = 5)	AET > 4% (n = 13)	P value (ERD vs NERD)1	P value (ERD with high AET vs NERD)1	P value (high AET vs RH)1	P value (high AET vs FH)1	P value (FH vs RH)1
Acid exposure time (%)	4.0 ± 4.3, 1.4-6.5	9.2 ± 5.1, 4.9-13.4	1.3 ± 1.1, 0.4-2.2	1.3 ± 0.9, 0.33-2.2	8.4 ± 3.6, 3.9-12.8	8.9 ± 4.4, 6.1-11.5	0.015	0.826	< 0.001	0.001	0.948
Total reflux events	52.6 ± 50.9, 21.8-83.3	55.7 ± 33.1, 28-83	40.2 ± 32.5, 13-67.3	23.6 ± 28.0, -5.8 to 52.9	98.1 ± 55.9, 28.7-167.5	72.0 ± 46.3, 44-100	0.469	0.143	0.148	0.016	0.121
SI for impedance refluxes (%)	24.6 ± 35.1, 3.4-45.8	14.7 ± 21.9, -3.6 to 33	29.7 ± 23.2, 10.2-49	0.2 ± 0.4, 0.2-0.5	56.5 ± 39.5, 7.5-105.5	30.8 ± 35.3, 9.4-52.1	0.481	0.038	0.510	0.079	0.002
SSI for impedance refluxes (%)	13.1 ± 21.3, 0.2-25.9	2.8 ± 5.0, -1.3 to 6.9	25.7 ± 21.8, 7.5-43.9	4.2 ± 10.2, -6.5 to 14.8	15.3 ± 13.3, -1.2 to 31.9	7.6 ± 10.7, 1.1-14.0	0.273	0.077	0.010	0.204	0.012
SAP for impedance refluxes (%)	45.1 ± 50.3, 14.6-75.4	36.3 ± 50.2, -5.6 to 78	96.4 ± 9.0, 88.8-103.9	6.5 ± 15.9, -10.1 to 23	79.8 ± 44.6, 24.4-135.2	53.1 ± 51.2, 22.1-83.9	0.433	0.036	0.111	0.078	0.001
Distal MNBI (3, 5, 7, 9)	2452.3 ± 1042.9, 1822-3082	1158.3 ± 350.5, 865-1451	2526.0 ± 727.5, 1917-3134	2561.1 ± 651.7, 1877-3245	1751.8 ± 769.1, 796.8-2706.6	1386.6 ± 599.3, 1024.4-1748.6	0.001	0.079	0.004	0.007	0.699
PSPW index (%)	86.6 ± 57.7, 51.7-121.5	61.4 ± 18.5, 45.9-76.8	83.3 ± 18.1, 68.2-98.4	68.9 ± 30.9, 36.4-101.3	61.3 ± 23.8, 31.8-90.7	61.4 ± 19.7, 49.4-73.2	0.147	1.000	0.011	0.598	0.604

¹Mann-Whitney U test.

ERD: Erosive reflux disease; NERD: Non-erosive reflux disease; RH: Reflux hypersensitivity; FH: Functional heartburn; AET: Acid exposure time; SI: Symptom index; SSI: Symptom sensitivity index; SAP: Symptom association probability; MNBI: Mean nocturnal baseline impedance; PSPW: Post-reflux swallow-induced peristaltic wave.

Table 2 Patient characteristics of erosive reflux disease, non-erosive reflux disease, reflux hypersensitivity, and functional heartburn, n (%)/mean ± SD, 95% confidence interval

Metrics per 24 hours	NERD (n = 8)	ERD with AET > 4% (n = 5)	AET > 4% (n = 13)	RH (n = 8)	FH (n = 6)	P value (ERD with high AET vs NERD)	P value (high AET vs RH)	P value (high AET vs FH)	P value (FH vs RH)
Symptom characteristics
Satisfactory response to anti-reflux treatment	5 (62.5)	4 (80)	9 (69.2)	5 (62.5)	3 (50)	1.0001	1.01	0.6171	1.0001
GERD screening tool score	56.75 ± 20.6, 39.5-74	45.4 ± 14.1, 27.8-62.9	52.4 ± 18.6, 41.1-63.6	66.3 ± 39.3, 33.4-99	52.3 ± 23.0, 28.1-76.5	0.3771	0.8851	1.0001	0.7461
Heartburn score	13.9 ± 7.6, 7.5-20.2	9.4 ± 5.6, 0.7-18.0	12.2 ± 7.4, 7.7-16.6	12.6 ± 3.5, 9.6-15.5	11.2 ± 7.5, 3.3-19.0	0.3641	0.8251	0.7861	0.3581
Regurgitation score	9.8 ± 6.9, 4-15.4	14.8 ± 5.6, 7.8-21.7	11.7 ± 6.7, 7.7-15.7	13.0 ± 8.6, 5.8-20.1	13.3 ± 7.0, 5.9-20.7	0.1561	0.7651	0.5031	0.7871
Chest pain score	10.3 ± 5.6, 5.5-14.9	9.4 ± 5.6, 2.5-16.2	9.9 ± 5.4, 6.7-13.1	10.0 ± 8.6, 2.8-17.1	5.0 ± 4.8, 0.1-10.0	1.0001	0.7411	0.0911	0.3191
Bloating score	10.1 ± 6.8, 4.4-15.8	1.0 ± 0	6.6 ± 7, 2.4-10.8	9.4 ± 8.2, 2.4-16.2	5.7 ± 7.9, 2.6-13.9	0.0071	0.3691	0.6341	0.2801
Dysphagia score	2.8 ± 3.2, 0.4-5.4	3.8 ± 6.3, -3.9 to 11.5	3.2 ± 4.4, 0.48-5.8	6.4 ± 7.6, 0.006-12.7	4.3 ± 7.7, -3.7 to 12.4	1.0001	0.1811	0.6511	0.5661
Cough score	4.8 ± 7.3, -1.3 to 10.8	3.2 ± 4.9, -2.9 to 9.3	4.2 ± 6.3, 0.36-7.9	5.8 ± 6.8, 0.08-11.4	8.0 ± 8.3, -0.7 to 16.7	0.7661	0.5251	0.2641	0.6161
Burping score	7.0 ± 5.0, 2.8-11.1	5.4 ± 1.5, 3.5-7.2	6.4 ± 4.0, 3.9-8.7	7.8 ± 5.3, 3.3-12.1	4.8 ± 4.0, 0.6-9.0	0.7091	0.6061	0.4701	0.2881
Factors associated with GERD symptoms
Age (years)	38.8 ± 9.9, 39-43	32.8 ± 6.6, 25-41	36.5 ± 8.9, 31-41	34.8 ± 9.9, 26.5-43	35.8 ± 9.7, 25.6-46	0.1631	0.6901	0.8601	0.7471
Sex (male)	3 (37.5)	3 (60)	6 (46.2)	4 (50)	5 (83.3)	0.5922	1.02	0.1772	0.3012
Married	5 (62.5)	2 (40)	7 (53.8)	5 (62.5)	4 (66.7)	0.5922	1.02	1.0002	1.02
PSS score	17.0 ± 6.3, 11.7-22.2	12.2 ± 1.9, 9.8-14.6	15.1 ± 5.5, 11.8-18.5	13.9 ± 5.3, 9.4-18.3	15.0 ± 3.6, 11.2-18.7	0.0551	0.4211	0.8241	0.3931
Abdominal obesity (Asian cutoffs)	2 ± 25	3 ± 60	5 ± 38.5	3 ± 37.5	1 ± 16.7	0.2932	1.02	0.6052	0.5802
BMI (kg/m2)	25.8 ± 4.2, 22.2-29.3	26.0 ± 4.7, 29.3-31.9	25.9 ± 4.2, 23.3-28.4	23.0 ± 3.8, 19.8-26.2	22.7 ± 2.5, 20-25.3	0.7701	0.1111	0.1141	0.9481
Physical activity level (MET minute/week)	211.1 ± 433.3, -151 to 573	1076.4 ± 1439.1, 710-2863	543.9 ± 995.9, -57.8 to 1145.7	914.1 ± 890.1, 169.3-1658	3409.0 ± 4040.1, -830 to 7648	0.0801	0.1091	0.0131	0.2451
History of abdominal surgery	2 (25)	1 (20)	3 (23.1)	2 (25)	1 (16.7)	1.0002	1.0002	1.0002	1.0002
Those with asthma	0 (0)	0 (0)	0 (0)	2 (25)	2 (33.3)	-	0.1332	0.0882	1.0002
Those with diabetes mellitus	2 (25)	0 (0)	2 (15.4)	0 (0)	0 (0)	0.4872	0.5052	1.0002	-
Caloric intake (kcal)	2235.0 ± 732.7, 1622-2847	1944.4 ± 684.1, 1094.9-2793.8	2123.3 ± 700.6, 1699-2546	1861.7 ± 539.9, 1410-2313	2083.9 ± 219.6, 1853-2314	0.3801	0.3461	0.7921	0.5191
Carbohydrate intake (g)	420.3 ± 141.2, 302-538	348.2 ± 132.4, 183.7-512.6	392.6 ± 137.1, 309.6-475.4	323.4 ± 91.3, 247-399.6	349.0 ± 54.0, 292.3-405.7	0.3801	0.3111	0.5991	0.6991
Fat intake (g)	34.9 ± 13.1, 23.9-45.7	35.5 ± 18.3, 12.7-58.2	35.1 ± 14.5, 26.3-43.9	40.9 ± 21.6, 22.8-58.9	36.0 ± 8.3, 27.2-44.6	1.0001	0.7721	0.4831	0.8971
Protein intake (g)	55.6 ± 18.5, 40-71	61.1 ± 12.9, 45.1-77.1	57.7 ± 16.2, 47.8-67.5	51.3 ± 19.2, 35.2-67.3	51.0 ± 7.8, 42.8-59.2	0.6611	0.1921	0.1881	0.5191
Fiber intake (g)	22.7 ± 11.8, 12.7-32.5	20.8 ± 10.1, 8.2-33.3	21.9 ± 10.8, 15.4-28.4	18.3 ± 10.0, 9.9-26.6	22.8 ± 9.5, 12.7-32.8	0.6611	0.3461	0.9301	0.3661
Symptoms for spicy food	6 (75)	3 (60)	9 (69.2)	7 (87.5)	4 (66.7)	1.0002	0.6062	1.0002	0.5382
Symptoms for oily food	5 (62.5)	3 (60)	8 (61.5)	7 (87.5)	4 (66.7)	1.0002	0.3362	1.0002	0.5382
Symptoms for wheat-based food	2 (25)	2 (40)	4 (30.8)	6 (75)	4 (66.7)	1.0002	0.0802	0.3192	1.0002
Symptoms for bread	5 (62.5)	3 (60)	8 (61.5)	6 (75)	5 (83.3)	1.0002	0.6562	0.6052	1.0002

¹Mann-Whitney U test for scale data.

²Fisher’s exact test for categorical data.

NERD: Non-erosive reflux disease; ERD: Erosive reflux disease; AET: Acid exposure time; RH: Reflux hypersensitivity; FH: Functional heartburn; GERD: Gastroesophageal reflux disease; PSS: Perceived stress scale; BMI: Body mass index; MET: Metabolic equivalent of task.

Table 3 Summary of key findings from the present study and compared with selected international studies

Ref.	Sample size	Esophagitis (%)	Barrett’s esophagus (%)	Abnormal AET (%)
Present study, 2025	209	33% (n = 199)	3% (n = 199)	28% (n = 46)
Ye et al[141], 2017	110	31%	NR	31%
Ford et al[142], 2010	> 5000	13.4%	NR	NR
Dent et al[23], 2010	203	57%	NR	64.9%
Xiao et al[143], 2009	64	31.3%	NR	34.4%

AET: Acid exposure time; NR: Not relevant.