CLINICAL CHARACTERISTICS AND NATURAL-HISTORY OF SYMPTOMATIC BUT NOT EXCESS GASTROESOPHAGEAL REFLUX

Esophageal pH monitoring in patients with gastroesophageal reflux symp toms identifies some who have normal esophageal acid exposure but neve rtheless a convincing correlation between symptoms and those reflux ev ents that do occur. These patients may exhibit enhanced sensory percep tion of physiological reflux. Little is known about the natural histor y of reflux symptoms in this group, which in our experience comprises up to 6% of those referred for diagnostic pH monitoring. We have there fore followed up by postal questionnaire 70 patients whose initial pH study had demonstrated normal acid exposure but a symptom index greate r than or equal to 50% and 58 patients found to have excess reflux, fo r a median of 4.4 and 6.5 years, respectively. The presenting characte r and frequency of symptoms and endoscopic and manometric findings wer e similar in the two groups. At review overall symptom frequency had i mproved (P < 0.01) for both groups similarly. However, 87% of those wi th normal acid exposure and 79% of those with excess reflux remained s ymptomatic, 53% and 47%, respectively, recording their symptoms to be the same or worse than at original presentation, despite over 60% in e ach group continuing to take regular medication. Only six patients in each group were asymptomatic and receiving no therapy at the time of r eview. The results demonstrate that patients with symptomatic but not excess gastroesophageal reflux constitute a significant clinical probl em. Both the persistence of their symptoms and their requirement for t herapy are similar to that observed in ''genuine'' refluxers.