title: Relationship between vomiting reflex during esophagogastroduodenoscopy and dyspepsia symptoms.
abstract: OBJECTIVE
  Although frequent vomiting reflexes during esophagogastroduodenoscopy (EGD) causes suffering in patients, very few studies have investigated the characteristics of subjects who frequently develop vomiting reflexes. This study examined the incidence of the vomiting reflex and related factors, especially upper gastrointestinal symptoms, among individuals undergoing transoral EGD.
  
  
  METHODS
  Subjects included 488 consecutive adults (mean age, 56.1 ± 8.9 years) who underwent transoral EGD for gastric cancer screening between February 2010 and March 2011. All procedures were performed by an endoscopist with 15 years of experience. Based on a questionnaire survey using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), symptoms (dyspepsia and acid reflux symptoms) and the number of vomiting reflexes during EGD were recorded.
  
  
  RESULTS
  Of the 488 subjects, 271 (56%) developed vomiting reflexes (mean, 4.2 times). This reflex-positive group was younger (54.3 ± 9.5 years) than the reflex-negative group (58.3 ± 7.7 years, P < 0.001). The number of subjects in the reflex-positive group with a high FSSG dyspepsia score (2.27 ± 2.57 vs 1.23 ± 1.84; P < 0.001), acid reflux symptom score (1.96 ± 2.22 vs 1.34 ± 2.14; P < 0.01) or an esophageal hiatal hernia (14.8% vs 4.6%; P < 0.001) was significantly higher than in the reflex-negative group. Multivariate analysis also showed a significant correlation between these four factors and the occurrence of vomiting reflexes. Using an FSSG dyspepsia score of 1 as the cut-off offered 68% sensitivity and 57% specificity for predicting the occurrence of vomiting reflexes.
  
  
  CONCLUSIONS
  Based on FSSG questionnaire responses on upper gastrointestinal symptoms, dyspepsia symptoms, in particular, are related to presence of vomiting reflexes during EGD.
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Japan. shoe@orion.ocn.ne.jp
authors.forename: Shotaro
authors.initials: S
authors.lastname: Enomoto
authors.forename: Mika
authors.initials: M
authors.lastname: Watanabe
authors.forename: Takeichi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Chizu
authors.initials: C
authors.lastname: Mukoubayashi
authors.forename: Kosaku
authors.initials: K
authors.lastname: Moribata
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Muraki
authors.forename: Naoki
authors.initials: N
authors.lastname: Shingaki
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Deguchi
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ueda
authors.forename: Izumi
authors.initials: I
authors.lastname: Inoue
authors.forename: Takao
authors.initials: T
authors.lastname: Maekita
authors.forename: Mikitaka
authors.initials: M
authors.lastname: Iguchi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Masashi
authors.initials: M
authors.lastname: Oka
authors.forename: Osamu
authors.initials: O
authors.lastname: Mohara
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
mesh_terms: D004415:Dyspepsia / Q000209:etiology* / Q000503:physiopathology; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012018:Reflex / Q000502:physiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000150:complications / Q000503:physiopathology*