Real-world prevalence of endoscopic findings in patients with gastroesophageal reflux symptoms: a cross-sectional study

Background and study aims Data regarding endoscopic findings and symptom correlation in patients with gastroesophageal reflux disease (GERD) symptoms are largely limited to single-center experiences. We performed a nationwide study to examine the association between patient-reported GERD symptoms and clinically relevant endoscopic findings. Patients and methods Using the National Endoscopic Database, we retrospectively identified all esophagogastro-duodenoscopies (EGDs) performed for GERD symptoms from 2000 to 2014.Patients were categorized into three symptom groups: 1) typical reflux only (R); 2) airway only (A); and 3) both R and A (R +A). Outcomes were the point prevalence of endoscopic findings in relation to patient-reported GERD symptom groups. Statistical analyses were performed using R. Results A total of 167,459 EGDs were included: 96.8% for R symptoms, 1.4% for A symptoms, and 1.8% for R+A symptoms. Of the patients, 13.4% had reflux esophagitis (RE), 9.0% Barrett's esophagus (BE), and 45.4% hiatal hernia (HH). The R + A group had a significantly higher point prevalence of RE (21.6% vs. 13.3% and 12 %; P<0.005) and HH (56.9% vs. 45.3 % and 38.3%; P< 0.005) compared to the R or A groups, respectively. The R group had a significantly higher point prevalence of BE compared to the A or R +A groups, respectively (9.1 % vs. 6.1 % and 6.1 %, P< 0.005). Conclusions On a national level, patients experiencing R+ A GERD symptoms appear more likely to have RE and HH, while those with only R symptoms appear more likely to have BE. These real-world data may help guide how providers and institutions approach acid-suppression therapy, set thresholds for recommending EGD, and develop management algorithms.