Endoscopic treatment for atypical manifestations of gastroesophageal reflux disease.
OBJECTIVE
Atypical manifestations are common in patients with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the response of atypical manifestations of GERD to endoscopic antireflux treatment.


METHODS
Patients with atypical manifestations of GERD including hoarseness, cough, wheezing, and non-cardiac chest pain were studied. Endoscopic antireflux treatment consisted of placement of sutures below the squamo-columnar junction. Clinical response was defined as complete resolution of the atypical symptom. Patients were followed clinically for up to 3 yr after the procedure. Short-term response was evaluated within 6 months of the procedure, and long-term follow-up was determined 1-3 yr after the procedure.


RESULTS
Forty-three patients met the inclusion criteria; four patients underwent repeat procedures during the study period and were excluded from the analysis. Long-term follow-up was available in all 39 patients. Short-term response counts were: hoarseness, 12 of 19 patients, cough, 17 of 19; wheezing, 8 of 9; and chest pain, 13 of 18. Long-term follow-up of patients (mean of 18 months) for these symptoms was not significantly different compared to short-term response.


CONCLUSIONS
Endoscopic suturing of the gastroesophageal junction appears to be a possible treatment option for atypical manifestations of GERD and future studies are needed to determine its role in management.
Division of Gastroenterology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Julia J
JJ
Liu
David L
DL
Carr-Locke
Mark T
MT
Osterman
Xin
X
Li
Rie
R
Maurer
David C
DC
Brooks
Stanley W
SW
Ashley
John R
JR
Saltzman
D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology*; D003371:Cough / Q000209:etiology*; D004943:Esophagogastric Junction / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006685:Hoarseness / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome