title: Non-esophageal symptoms cannot differentiate between erosive reflux esophagitis and non-erosive reflux disease in a referred population.
abstract: BACKGROUND
  Non-esophageal symptoms are highly prevalent in non-erosive reflux disease (NERD). However, their prevalence in erosive esophagitis (ErE) is unclear. The aims of this study were to compare patients with pH-positive NERD and ErE in terms of non-esophageal symptoms and to investigate whether such symptoms can differentiate between these two conditions.
  
  
  METHODS
  A prospective observational study of ErE and pH-positive NERD patients matched for age and gender with a nested case-control analysis. Symptoms were scored on validated scales. The association between the scale scores and diagnosis was evaluated in a random group comprising 67% of the total (group A) and was validated on the rest (group B).
  
  
  RESULTS
  124 ErE and 248 pH-positive NERD patients were studied. In group A, pH-positive NERD patients scored higher than ErE patients on all symptom scales. Scores on chest, constipation, sleep and urinary symptoms scales were significantly associated with diagnosis. A composite weighted score on these scales was 41.5% sensitive and 86.0% specificity in the differentiation of ErE from pH-positive NERD patients. When applied to group B, the sensitivity and specificity of this score were 48.8% and 70.3%, respectively.
  
  
  CONCLUSIONS
  Digestive and non-digestive symptoms occurred with a significant higher prevalence in pH-positive NERD compared with ErE patients. However a composite score on scales of constipation, chest, sleep and urinary symptoms was not enough sensitive and specific to differentiate these two conditions.
authors.affiliation: Gastroenterology Unit, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zimmerman
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Hershcovici
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002637:Chest Pain / Q000150:complications; D003248:Constipation / Q000150:complications; D003371:Cough / Q000150:complications; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000150:complications; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000150:complications