title: Significance and degree of reflux in patients with primary extraesophageal symptoms.
abstract: OBJECTIVE
  Patients with extraesophageal symptoms are often suspected of having gastroesophageal reflux disease (GERD). However, the true prevalence and severity of reflux disease is not well studied. In this group of patients, the objectives of our study were to determine the prevalence and severity of esophageal acid exposure and classify the endoscopic findings.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  One hundred twenty-eight patients with extraesophageal symptoms underwent 48 hours of Bravo pH monitoring. Percent of time that pH was <4 (total upright and supine) was measured. Severity of reflux was categorized by the percent of total time pH was <4, with mild = >4.2% but <10%, moderate = 10% to 20%, and severe>20%. Endoscopic signs of esophagitis and Barrett's esophagus were determined.
  
  
  RESULTS
  There were 104/128 (81%) patients who had abnormal esophageal acid exposure, 44% in the upright and supine position, 38% in the upright position only, and 18% in the supine position only. There were 59/128 (46%) patients with mild reflux, 40/128 (31%) with moderate, and only 5/128 (4%) patients with severe reflux. 23/128 (18%) patients had evidence of esophagitis. Only 1/128 (0.8%) patients had pathologic Barrett's esophagus. Prevalence of abnormal esophageal acid exposure was similar in those with (75%) or without (66%) concomitant heartburn and/or regurgitation (P = .3).
  
  
  CONCLUSIONS
  Abnormal esophageal pH is common in patients with extraesophageal symptoms. Most have only mild (46%) to moderate (31%) reflux with a low prevalence of esophagitis (18%) or Barrett's esophagus (0.8%). The degree of esophageal acid reflux cannot be predicted from baseline presence or absence of typical GERD symptoms.
authors: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
authors: Kenneth C
authors: KC
authors: Fletcher
authors: Marion
authors: M
authors: Goutte
authors: James C
authors: JC
authors: Slaughter
authors: C Gaelyn
authors: CG
authors: Garrett
authors: Michael F
authors: MF
authors: Vaezi
mesh_terms: D000328:Adult; D017677:Age Distribution; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology*; D006356:Heartburn / Q000175:diagnosis / Q000453:epidemiology; D006685:Hoarseness / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric