Gastroesophageal Reflux Symptoms in Typical and Atypical GERD

Roles of Gastroesophageal Acid Refluxes and Esophageal Motility

Tanisa Patcharatrakul; Sutep Gonlachanvit


J Gastroenterol Hepatol. 2014;29(2):284-290. 

In This Article

Abstract and Introduction


Background/Aim: To determine the roles of gastroesophageal acid reflux (GER) and esophageal dysmotility on typical and atypical GERD symptoms.

Methods: Two hundred thirty-six patients (159 females, age 47 ± 14 years) with typical and atypical GERD symptom(s) for > 3 months underwent standard water perfused esophageal manometry (EM) and 24 h esophageal pH studies during off therapy.

Results: Eighty seven and 93 patients had positive lower esophageal pH tests and abnormal EM, respectively. Patients with positive lower esophageal pH test were significantly older (50 ± 13 vs 45 ± 13 years, P < 0.005) and had higher prevalence of acid regurgitation symptoms than patients with negative test (56/87 vs 72/149, P < 0.05). Patients with positive upper esophageal pH test (n = 67) also had significantly higher prevalence of acid regurgitation symptoms (43/67 vs 74/152, P < 0.05). Prevalence of other upper gastrointestinal and respiratory symptoms were similar between patients with positive and negative upper and lower pH test. Patients with abnormal EM were significantly older (49 ± 14 vs 45 ± 13 years, P < 0.05) and had higher prevalence of chronic cough than patients with normal EM(30/93 vs 26/143, P < 0.05). In patients with positive pH tests, the prevalence of dysphagia, chronic cough, and hoarseness of voice were significantly higher in patients with abnormal than those with normal EM (18/31 vs 18/56, P < 0.05; 12/31 vs 6/56, P < 0.005 and 19/31 vs 18/56, P < 0.01, respectively). Whereas in patients with negative lower pH tests, only the prevalence of heartburn was significantly lower in patients with normal than those with abnormal EM (26/87 vs 30/62, P < 0.05).

Conclusions: Acid regurgitation but not heartburn was associated with GER. Esophageal dysmotility had no significant effect on acid regurgitation symptom but associated with chronic cough, hoarseness of voice, and dysphagia only in patients with abnormal esophageal acid exposure.


Gastroesophageal reflux disease (GERD) is common in the general population worldwide. The heartburn and acid regurgitation symptoms have been considered as typical and specific symptoms for gastroesophageal reflux disease.[1] However, not only these typical GERD symptoms but also atypical symptoms such as noncardiac chest pain, chronic cough, hoarseness of voice, throat irritation, globus sensation, and increase throat secretion have been reported to be associated with GERD.[2–5]

Esophageal motility disorders have been reported to be present in 25–48% of GERD patients[6–8] and increasing prevalence with increasing severity of reflux esophagitis.[7] The disorders were found to be associated with delayed clearance of gastroesophageal reflux contents[9,10] and may increase a prevalence of laryngopharyngeal refluxes.[11] Although the gastroesophageal acid refluxes and ineffective esophageal contractions have been considered as a major pathophysiologic mechanism of gastroesophageal reflux disease, the interplay between abnormal gastroesophageal acid refluxes and esophageal dysmotility with typical and atypical GERD symptoms have not been well explored. Previous studies in western countries suggested that the increased acid exposure in the esophagus is associated with heartburn and/or acid regurgitation,[12,13] noncardiac chest pain,[14] chronic cough,[15] and chronic laryngo-pharyngeal symptoms,[16] but the effect of esophageal dysmotility on the development of these symptoms was not clearly shown.

Therefore, the aim of this study was to determine the roles of abnormal esophageal acid exposure and ineffective esophageal motility on the presence of typical and atypical GERD symptoms in patients who were suspected of having GERD.