title: Prompt upper endoscopy is an appropriate initial management in uninvestigated chinese patients with typical reflux symptoms.
abstract: OBJECTIVE
  We sought to investigate the prevalence of clinically significant endoscopic findings (CSEFs) in Chinese patients presenting with uninvestigated typical reflux symptoms in the absence of alarm symptoms, and to evaluate whether prompt endoscopy is an appropriate initial management in these patients.
  
  
  METHODS
  Consecutive patients presenting with uninvestigated typical reflux symptoms (i.e., heartburn or acid regurgitation) as chief complaints were recruited for symptom evaluation and upper endoscopy, followed by a 2-week proton pump inhibitor (PPI) therapy.
  
  
  RESULTS
  Of 469 patients recruited, CSEFs were observed in 180 (38.4%): 154 (32.8%) with erosive esophagitis (EE), 18 (3.8%) with Barrett's esophagus (BE), 24 (5.1%) with peptic ulcer disease (PUD), and 4 (0.9%) with carcinomas (1 esophageal carcinoma and 3 gastric adenocarcinomas). Multivariate analysis identified that an age >50 years (odds ratio (OR)=1.94, P=0.008), male gender (OR=4.11, P<0.001), being overweight or obese (OR=2.99, P<0.001), and alcohol use (OR=9.96, P<0.001) were independent risk factors for EE; an age >50 years (OR=4.61, P=0.003) and alcohol use (OR=5.50, P=0.003) were independent risk factors for BE; and Helicobacter pylori infection (OR=8.52, P<0.001) and alcohol use (OR=4.08, P=0.004) were independent risk factors for PUD. Symptom evaluation and response to PPI treatment were not correlated with EE, BE, and PUD in these patients.
  
  
  CONCLUSIONS
  CSEFs other than gastroesophageal reflux disease are present in a considerable proportion of Chinese patients with uninvestigated typical reflux symptoms but without alarm features. Symptom evaluation is of limited practical value, and thus prompt endoscopy seems to be an appropriate initial management option in these patients.
authors.affiliation: Division of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Sui
authors.initials: S
authors.lastname: Peng
authors.forename: Li-Shou
authors.initials: LS
authors.lastname: Xiong
authors.forename: Ying-Lian
authors.initials: YL
authors.lastname: Xiao
authors.forename: Jin-Kun
authors.initials: JK
authors.lastname: Lin
authors.forename: An-Jiang
authors.initials: AJ
authors.lastname: Wang
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.forename: Pin-Jin
authors.initials: PJ
authors.lastname: Hu
authors.forename: Min-Hu
authors.initials: MH
authors.lastname: Chen
mesh_terms: D000428:Alcohol Drinking; D044466:Asian People; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis*; D016099:Endoscopy, Gastrointestinal; D004941:Esophagitis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D050177:Overweight / Q000150:complications; D010437:Peptic Ulcer / Q000150:complications / Q000175:diagnosis*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors