Hypersensitive esophagus: can it be classified as a subgroup of gastroesophageal reflux disease?

Background/aims: Gastroesophageal reflux disease is one of the most common gastrointestinal diseases of adulthood. Hypersensitive esophagus is a new term which defines patients with reflux symptoms, negative endoscopic findings and normal acid contact time on 24 hour pH analysis, although there is a convincing relationship between symptoms and acid reflux episodes on pH analysis- positive symptom index. In this study, the frequency of hypersensitive esophagus among patients with heartburn was determined and demographic findings, symptoms, manometric and pHmetric findings were compared among hypersensitive esophagus, non-erosive reflux disease, erosive reflux disease and normals.

Methods: Patients admitted to hospital with heartburn and without any cardiac, severe gastric or duodenal pathologies (except minimal antral gastritis) and with no abnormal manometric findings suggestive of esophageal motility disorders were included in the study. All patients were questioned about age, height, weight, educational status and intestinal and extraintestinal reflux related symptoms. Upper endoscopy, esophageal manometry and 24 hour pH monitoring were performed respectively.

Results: Of the 44 patients (17 male, 27 female) included in the study, seven (16%) had hypersensitive esophagus, 15 (34%) had non-erosive reflux disease, seven (16%) had erosive reflux disease and 15 (34%) had normal findings. The female ratio in the hypersensitive esophagus and normal groups was higher while the male ratio was higher in erosive reflux disease. There was no significant difference among groups according to age, body mass index and symptoms. There was also no significant difference according to manometric findings. De Meester scores were significantly lower in hypersensitive esophagus and normal groups while symptom index was highest in the hypersensitive esophagus group. Reflux was observed especially in the upright position in all groups.

Conclusion: The ratio of hypersensitive esophagus, gastroesophageal reflux disease and no pathology in patients with heartburn was 16%, 50% and 34% respectively. It would be appropriate to accept hypersensitive esophagus as a subgroup of reflux disease as it has both symptoms and some manometric and pHmetric changes.