The presentation of reflux esophagitis, hiatal hernia, Barrett’s esophagus and ‘reflux-like’ dyspepsia: a prospective clinical and endoscopic study

Abstract

The prevalence, number, and severity of symptoms in patients with esophagitis, hiatal hernia, Barrett’s esophagus and ‘reflux-like’ dyspepsia was assessed in a prospective consecutive endoscopic and clinical study. Consecutive patients received a questionnaire consisting of 82 questions, 12 of which referred to upper abdominal complaints. A symptom score was calculated. A total of 115 patients with esophagitis, 29 patients with Barrett’s esophagus, 108 patients with hiatal hernia and 439 patients with dyspepsia without endoscopic abnormalities (‘reflux-like dyspepsia’) were included. Only 5.5% of the patients had no reflux complaints. The symptom score and the number of complaints in patients with Grades I or II reflux esophagitis were significantly higher than in patients of the other groups. Presence of dysphagia was significantly higher in patients with Grades III or IV esophagitis. Patients with Grades III or IV esophagitis had a significantly shorter history. The presence of the majority of reflux symptoms with a high symptom score has a high predictive value for Grades I or II esophagitis, while the presence of dysphagia has a high predictive value for Grades III and IV esophagitis. In case of a lower number of symptoms or a lower symptom score, it is not possible to discriminate between hiatal hernia, esophagitis, Barrett’s esophagus or ‘reflux-like’ dyspepsia.