The role of endoscopy, 24 hour ambulatory esophageal pH monitor and bernstein test for gastroesophageal reflux disease and its relationship with symptom

Lee, Kyoung Soo; Kim, Nayoung; Park, Ran Young; Kim, Chung Hyun; Kim, Hyun Young; Park, Young Soo; Hwang, Jin Hyok; Kim, Jin Wook; Lee, Dong Ho; Jung, Hyun Chae; Song, In Sung

Abstract

BACKGROUND: The aim of this study is to evaluate the diagnostic usefulness of endoscopy, 24 hour esophageal pH monitor and Bernstein test for GERD and its relationship with GERD symptom in the presence or absence of reflux esophagitis (RE).
METHODS
This study was performed for 168 patients with GERD. Clinical symptoms and the results of endoscopy, 24 hour esophageal pH monitor, esophageal manometry with Bernstein test were analyzed.
RESULTS
168 (42%) of 403 patients who complained symptoms suggestive of GERD were diagnosed as GERD (65% as RE, 35% as nonerosive reflux disease) using diagnostic tools for GERD. The most chief complaint symptoms were heartburn (18.5%), regurgitation (18.5%), noncardiac chest pain (10.7%), cough (10.7%), laryngeal symptoms (11.3%), non specific dyspepsia (24.4%) and others (6%). When comparison of symptoms depending on RE among GERD patients was performed, laryngeal symptoms were significantly more frequent in patients without RE (p=0.001), and dyspepsia in patients with RE (p<0.001), respectively. Regarding diagnostic efficacy of each test depending on symptom, patients with heartburn showed higher positive rate of Bernstein test (p=0.035) and patients with laryngeal symptoms showed higher positive rate of 24 hour esophageal pH monitor (p=0.015), respectively. In addition, there was no correlation among endoscopy, 24 hour esophageal pH monitor and Bernstein test in the diagnosis of GERD by Kappa index.
CONCLUSIONS
Typical reflux symptoms of GERD such as heartburn and regurgitation were found in 37% of GERD patients in Korea, lower than in Western countries. The lack of correlation among the diagnostic tools for GERD suggests that these tools are complementary to each other for the diagnosis of GERD.