The prevalence of pathologic acid exposure of patients with reflux symptom is low while 1/3 of patients with epigastric symptoms have pathological acid exposure in China. The aim was to evaluate and to compare the relevance of esophageal and epigastric symptoms for gastroesophageal reflux disease (GERD) diagnosis in China.
Consecutive outpatients with predominant esophageal symptoms (heartburn, regurgitation, chest pain, dysphagia) or predominant epigastric symptoms (epigastric pain, epigastric burning, early satiety, postprandial fullness) were enrolled. Patients had upper endoscopy and esophageal function tests performed, and took esomeprazole treatment. The prevalence of GERD and proton pump inhibitor (PPI) efficacy was assessed and compared amongst patients with different predominant symptoms.
A total of 374 patients (244 with esophageal symptoms and 130 with epigastric symptoms) were enrolled. Patients with predominant epigastric symptoms had slightly lower prevalence of reflux esophagitis and pathological acid exposure but significantly lower PPI response rate than those with esophageal symptoms. Multivariable logistic regression analysis revealed that predominant symptom independently predicted PPI efficacy while couldn’t predict the objective evidence of GERD. A total of 154 patients (41.18%) had objective evidence of GERD, 30% of whom complained of predominant epigastric symptoms and had similar reflux profiles and symptom outcome as GERD patients with esophageal symptoms.
Approximately 30% of GERD patients complain of predominant epigastric symptoms and have comparable reflux profiles and symptom outcome to those with predominant esophageal symptoms. Epigastric symptoms may be part of the diagnosis for GERD in Chinese population.

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