Endoscopy-negative gastroesophageal reflux disease. The hypersensitive esophagus.
Gastroesophageal reflux disease (GERD) is one of the mos common disorders of the gastrointestinal tract. Patients with GERD symptoms may exhibit a spectrum of endoscopic findings ranging from normal endoscopy (EGD negative) to severe ulcerative esophagitis. Recent evidence indicates that a large proportion of patients with GERD have normal endoscopy. The use of 24-hour ambulatory pH testing in the evaluation of symptomatic patients with EGD negative GERD allows further classification of these subjects into groups. Patients who have abnormal acid exposure and a positive symptom index constitute one group and patients who have normal acid contact time but record a convincing relationship between their symptoms and acid reflux on the pH analysis--positive symptom index--form another group. The latter group has been suggested to have a hypersensitive esophagus or "functional heartburn." This article reviews the prevalence, clinical features, origin of patient's symptoms, natural history, and treatment of patients with EGD negative GERD.
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Division of Gastroenterology, Mayo Medical School, Mayo Clinic Jacksonville, Florida, USA.
D004945:Esophagoscopy; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans