Determinants of symptoms in gastroesophageal reflux disease

BACKGROUND: Nonerosive reflux disease (NERD) is detected frequently. Furthermore, as general checkups including endoscopy have become popular, silent erosive esophagitis (EE), which is defined as EE without the typical symptoms of gastroesophageal reflux disease (GERD), is also frequently encountered. We investigated the determinants of symptom presentation in symptomatic EE, NERD, and silent EE, which are representative GERD groups. MATERIALS AND METHODS: Participants in a prospective health-screening cohort underwent upper endoscopy from June 2009 to September 2010. GERD was defined as heartburn and/or acid regurgitation at least weekly or EE by endoscopy. All participants were asked to complete a validated questionnaire, which included questions about gastrointestinal symptoms and the somatization symptom checklist (SSC). RESULTS: Among 4565 participants (men, 51.9%; mean age, 46.0±10.2 years), GERD was found in 678 participants (14.9%) and EE in 335 participants (7.3%). Each group of participants was classified into the following three categories: (i) symptomatic EE (n=38, 5.6%); (ii) NERD (n=343, 50.6%); and (iii) silent EE (n=297, 43.8%). Male sex and obesity were common predictors in both the symptomatic and the silent EE groups compared with the control group. Higher scores on the SSC [odds ratio (OR), 3.7; 95% confidence interval (CI), 1.8-7.8] and overlap of functional dyspepsia (OR, 35.4; 95% CI, 14.9-84.3) were predictors of symptomatic EE compared with asymptomatic EE. Symptomatic EE was more strongly associated with male sex (OR, 7.8; 95% CI, 2.9-20.9) than was NERD. CONCLUSION: Somatization was the most important determinant of GERD symptoms. Silent EE was prevalent among participants with GERD, even though its natural history and clinical significance are unknown.