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

Materials and Methods


Consecutive patients with clinical symptoms suggestive of GERD who underwent esophageal manometry and 24-hr esophageal pH monitoring off therapy were included. The indications for 24-hr esophageal pH monitoring in our center were; (i) uncertain diagnosis in patients with atypical GERD symptoms (noncardiac chest pain, chronic cough, or chronic ear-nose-throat (ENT) symptoms; (ii) uncertain diagnosis in patients with overlapping typical GERD and functional dyspepsia symptoms; and (iii) patients with typical GERD symptoms who were refractory to treatment.

The inclusion criteria were patients who were 18–80 years-old, having at least one of these following clinical symptoms for more than 3 months; (i) heartburn and/or acid regurgitation, (ii) chronic idiopathic ENT symptoms including hoarseness of voice, throat clearing problem, sore throat, burning throat, mucous in the throat, and choking, (iii) chronic cough with unknown etiology, and (iv) angina-like chest pain with negative cardiologic evaluation(s). All patients who had dysphagia or other alarm features including age > 50 years old, anemia, or weight loss underwent upper endoscopy within 6 months prior to the studies. The exclusion criteria were: (i) patients with a previous history of esophageal or gastrointestinal surgery except appendectomy and cholecystectomy, (ii) patients who could not stop the medications that affect gastric acid secretion, gut motility and sensation including proton pump inhibitors (PPIs). H2 receptor antagonists, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRI), domperidone, metoclopramide, cisapride, itopride, antihistamine, and macrolide antibiotics for 7 days prior to the studies, (iii) pregnant women, (iv) patients with clinical symptoms suggestive of gut obstruction, (v) patients with history of advanced underlying medical/psychological conditions such as ischemic heart disease, heart failure, diabetes mellitus, chronic kidney disease, cirrhosis, chronic pancreatitis, a major neurological or psychological disease, and chronic obstructive pulmonary disease (COPD), and (vi) patients with peptic ulcer disease, cancer of the esophagus, stomach, or pancreas, gastric outlet obstruction, achalasia, and systemic sclerosis.

This study was approved by institution review board and all participants provided written informed consent before participating in this study.