Prompt upper endoscopy is an appropriate initial management in uninvestigated chinese patients with typical reflux symptoms.
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.
Peng
Sui
S
Division of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Xiong
Li-Shou
LS
Xiao
Ying-Lian
YL
Lin
Jin-Kun
JK
Wang
An-Jiang
AJ
Zhang
Ning
N
Hu
Pin-Jin
PJ
Chen
Min-Hu
MH
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
D054328:Proton Pump Inhibitors