Z Gastroenterol 2005; 43 - 164
DOI: 10.1055/s-2005-869811

Results of early endoscopy in patients with typical symptoms of GERD

L Vén 1, É Iszlai 1, S Ágoston 1, F Rácz 1, B Sipos 1, É Bátyi 1, B Kanyó 1, J Kiss 1
  • 12nd Department of Internal Medicine, Jósa András Hospital, Nyíregyháza, Hungary

Introduction: Patients with the typical symptoms of GERD, however without alarm signs, can be managed by the PPI test and an empirical treatment,

In this study we analysed the early endoscopic results in patients with typical symptoms. Our aim was to determine whether the diagnosis based on typical symptoms and the empirical treatment would suffice to treat patients in regions with a high prevalence of Hp, or whether it was necessary to perform the so-called initial endoscopy.

Method: Using a GERD questionnaire composed by Johnsson et al., we selected patients showing typical symptoms Patients characterised by alarm signs were excluded from the study, along with those with histories of peptic ulcer, or gastric operation, or those having taken NSAID regularly. Then we performed upper tract panendoscopy and analysed the results.

Findings: Of a total of 192 patients, 27 (14%) were found to have peptic ulcer, in 15 cases also accompanied by typical signs of ERD. All patients with ulcer were Hp positive. 19 (9%) cases were diagnosed with chronic gastritis, and three patients (2%) had ventricular polyp. One patient (0.5%) in each group had ventricular or cardiac tumour, esophageal varicosis as well as mycosis of the esophagus, 61 individuals (32%) were found to show typical signs of ERD. In 78 patients (41%), there were no changes in the upper gastrointestinal tract. We made a separate analysis of the results of 81 patients younger than 45 years of age. We found ulceration in 10 individuals (12%), which in 5 cases was later accompanied by symptoms of ERD. In 24 cases (30%), erosive esophagitis, in 9 cases (11%) chronic gastritis was found. There were negative endoscopic findings in 38 cases (47%).

Conclusions: In our county with a high prevalence of Hp. infection, peptic ulcer is frequent among patients with GERD, and among those with other changes not related with GERD, requiring special gastrointestinal attention. Based on our findings, we suggest that during evaluation gastroscopic examination should be considered in patients producing typical signs of GERD, and a PPI test without endoscopy and empirical treatment are not sufficient.