[Comparison of clinical features between gastroesophageal reflux diseases with atypical and typical symptoms].

Objective: To study the differences between gastroesophageal reflux disease (GERD) with atypical symptoms (a-GERD) and typical symptoms (t-GERD).

Methods: 30 patients of suspected a-GERD were recruited and examined with upper gastrointestinal endoscopy, high-resolution manometry (HRM), 24 h esophageal multichannel intra-luminal impedance monitoring with pH sensor (MII-pH) and proton pump inhibitor (PPI) trials. The results were compared with those of 33 cases of GERD with typical symptoms.

Results: Among the 30 patients of suspected GERD, 24 were confirmed with a-GERD. One third of those patients were over sixty-years old, significantly higher than those with typical GERD (P < 0.05). No significant differences in prevalence of esophageal mucosa breakage and esophageal manometry readings were found between the two groups (P > 0.05). The a-GERD patients had higher data readings in 24 h esophageal MCII-pH monitoring than the t-GERD patients (P < 0.05). Supine type of GER and mixed reflux were predominately seen in the a-GERD patients, while upright type of GER was predominate seen in the t-GERD patients. The response rate of PPI in the a-GERD patients was significantly lower than that in the t-GERD patients when a course of standard dosage of PPI was given (45.8% vs. 78.8%, P < 0.01). But there was no significant difference in PPI response between these two groups when a second course with double standard dosage of PPI combined with pro-motility agents were given (72.7% vs. 88.0%, P < 0.05).

Conclusion: Compared with patients of t-GERD, older onset age, more severe degree of acid reflux are presented in patients of a-GERD. a-GERD should be considered when it is hard to explain the symptoms of upper part of the chest in clinical practice. 24 h esophageal MII-pH monitoring and/or diagnostic therapy with double standard dosage of PPI helps make a correct diagnosis.