Can symptoms predict endoscopic findings in GERD?
BACKGROUND
It is difficult to decide which patients with reflux symptoms require endoscopy. The aim of this study was to develop a scoring system to predict esophageal findings at endoscopy.


METHODS
A consecutive sample of 1011 adult patients scheduled for upper endoscopy were asked to complete a validated symptom questionnaire. The endoscopy reports were abstracted. Individual logistic regression models were developed to predict esophagitis, Barrett's esophagus (long and short segment) and esophageal stricture, including Schatzki's ring.


RESULTS
Reflux esophagitis was independently associated with heartburn frequency (p<0.0001) but not severity or duration (p>0.05). Barrett's esophagus was associated with the duration of acid regurgitation (p<0.005) but not with frequency or severity (p>0.05). Strictures were associated with dysphagia severity (p<0.0001) and duration (p<0.0001) but not frequency (p>0.05). At a sensitivity of 80%, the models had a specificity of 49% for esophagitis, 57% for Barrett's esophagus, and 68% for strictures. At a specificity of 80%, the sensitivities were 51% for esophagitis, 62% for Barrett's esophagus and 71% for strictures.


CONCLUSIONS
Endoscopic findings were associated with distinct attributes of reflux symptoms. Symptoms are only modestly predictive of findings at endoscopy.
Division of Gastroenterology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
G Richard
GR
Locke
Alan R
AR
Zinsmeister
Nicholas J
NJ
Talley
D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis; D003680:Deglutition Disorders / Q000209:etiology; D016145:Endoscopy, Digestive System; D004940:Esophageal Stenosis / Q000175:diagnosis; D004941:Esophagitis / Q000175:diagnosis; D004942:Esophagitis, Peptic / Q000150:complications; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006356:Heartburn / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires