HEARTBURN, ESOPHAGITIS AND BARRETTS-ESOPHAGUS IN SELF-MEDICATING PATIENTS IN GENERAL-PRACTICE

A postal questionnaire on heartburn sent to 6760 randomly selected sub jects yielded 3971 replies suitable for analysis. Heartburn had never been experienced by 1665 (42%) respondents. Significant symptoms of mo re than three months' duration that had occurred at least once a month in the preceding 12 months were reported by 1337 (34%) respondents. O f these, 875 had not consulted their general practitioner and were inv ited to attend for a structured interview with questionnaire and upper gastrointestinal endoscopy. A total of 177 were interviewed, and 143 underwent upper gastrointestinal endoscopy. Of those endoscoped, 106 ( 74%) experienced symptoms at least once a week. These were relieved by alginate consumption in 97 (68% of) cases. Just nine (6%) patients ha d been taking H-2-receptor antagonists. Macroscopic appearances of oes ophagitis were seen in 46 cases [13 (6%) grade 1, 24 (11%) grade 2, fi ve (2%) grade 3, two (1%) grade 4, and two (1%) grade 5]. Three patien ts had mild strictures and six patients had Barrett's oesophagus. Ther e were no appearances suggestive of malignancy. Biopsies were taken in 122 cases, including all those in which abnormalities had been seen. Histological evidence of oesophagitis was seen in 47 cases. Gastric me taplasia was found in six cases and dysplasia seen in three. Patients who self-medicate for reflux symptoms have a low prevalence of pre-neo plastic and neoplastic pathology, A substantial proportion, however, h ave histological evidence of oesophagitis and a small number have meta plasia.