Etiology Analysis and Clinical Characteristics in Patients with Heartburn

Purpose: To study clinical classification and characteristics among the different heartburn groups. Methods: All patients were initially evaluated by a symptom questionnaire under the guidance of digestive physician, and thereafter underwent endoscopy. Patients with damaged esophageal mucosa were classified into RE type in GERD group. Those with normal-appearing esophageal mucosa were followed by ambulatory 24h esophageal pH monitoring including counting symptom index and then administrated by PPI trial. Those patients having a normal esophageal mucosa were stratified into NERD and FH based on 24h esophageal pH monitoring, symptom index and PPI trial, and the last analyse the different characteristics of different heartburn groups. Results: Eighty patients with typical heartburn symptoms were enrolled, including 43 male and 37 female, mean age 51±12 years. There was no statistically significant difference between three groups of age and gender. Combined with esophageal pH monitoring, symptom index and PPI trial, and NERD subdivided into 3 subgroups; 20 patients were testified with excessive acid exposure;13 patients were found with normal acid exposure and positive SI at the same time the other 13 cases had positive PPI trial although they had normal pH monitoring and negative SI. After complete classification, comparing the differences in esophageal pH monitoring of different classification. Statistical analysis shows the degree of esophageal acid exposure of NERD group (pH+ or pH-) was significantly higher than that of the FH group. There were significant differences of the degree of esophageal acid exposure among 3 subgroups of NERD. No significant differences were found on the degree of esophageal acid exposure between patients with positive PPI trial and those negative, no significant differences were found in the positive rate of PPI trial between patients with positive esophageal pH monitoring and those negative; there were significant differences in curative effect of PPI treatment between GERD group and FH group. Statistical analysis showed that reflux esophagus LA grade didn't have correlation with the symptom scores. Conclusion: Heartburn is a common symptom which can be found in a variety of diseases. Such as RE, NERD and FH. There were significant differences of the degree of esophageal acid exposure among 3 subgroups of NERD. The degree of esophageal acid exposure of NERD group (pH+ or pH-) of significantly was higher than that of the FH group. Esophageal pH monitoring results didn't have correlation with the PPI trial results.