The Role of Gastroesophageal Reflux (GER) in Patients with Nonspecific Upper
MOHAMMAD FARIVAR and JAMES
KOLTON, DEPT of MEDICINE and DEPT of PATHOLOGY,
NORWOOD HOSPITAL, NORWOOD, MA
Nineteen consecutive patients (12 female, 7 male) underwent upper GI endoscopy
(EGD) for evaluation of one or more symptoms of bloating, early satiety, anorexia,
nausea, vomiting and upper abdominal pain. They denied heartburn, chest pain,
diarrhea or constipation. There was no evidence of G.I. blood loss. Upper abdominal
ultrasound was normal in all and upper G.I. x-ray was unremarkable in 8 of
8. In each patient, laryngo-esophago-gastro-duodenoscopy (LEGD) was done, and
4 pinch biopsies were taken 2-4 cm from the gastro-esophageal junction to look
for microscopic chronic esophagitis.
Results: Endoscopy revealed gastritis, duodenitis, gastric ulcer or erosive
esophagitis in 9 patients (47%). 13 patients (68%) had reflux laryngitis (RL).
13 patients (68%) had chronic esophagitis by biopsy. 10 patients (53%) were
found to have both positive biopsy and RL. Only 2 of 10 patients had endoscopic
esophagitis (grades I-III). Of 3 patients with negative biopsy and no RL, one
had gastric ulcer and one had grade II esophagitis. GER patients responded
to appropriate medical treatment.
Conclusions: In this study of 19 patients with non-specific upper GI symptoms,
at least 10 (53%) had clinically unsuspected reflux, as proven by both positive
biopsy and the presence of RL during LEGD. All patients responded clinically
to anti-reflux treatment.