Wake Forest University School of Medicine Pasadena, CA, United States
Kelli Liu, BA1, Steven Clayton, MD2 1Wake Forest University School of Medicine, Pasadena, CA; 2Wake Forest Baptist Health, Winston-Salem, NC
Introduction: Introduction: Though most commonly known for heartburn and regurgitation, GERD is responsible for many “atypical” symptoms like chest pain and cough. The mechanisms behind this wide variety of presentations has not been extensively studied and the complex relationship between reflux character and symptom manifestation remains poorly understood. In particular, proximal frequency as a metric for predicting symptom presentation has never been examined. The aim of this research is to evaluate if increased proximal reflux frequency correlates with atypical symptom manifestation.
Methods: Patients being evaluated for GERD symptoms with pH-impedance monitoring. Patients pH-impedance studies were analyzed for symptom indication, type of indication (typical, atypical, mixed), acid exposure time, number and type of reflux episodes, mean nocturnal baseline impedance (MNBI) and symptom index and symptom association probability for reported symptoms during study. Proximal reflux frequency was impedance 15cm above the lower esophageal sphincter (LES); MNBI was impedance 3cm above the LES. Demographic data like age, BMI, ethnicity, gender, and select comorbidities was also collected. Typical was defined as heartburn, regurgitation, and reflux; atypical was all other complaints.
Results: 526 patients (75% female, mean age 55.5 years, n=69 typical, n=157 atypical, n=300 mixed) were included. None of the demographic data, reflux characteristics, or event counts differ significantly among the three groups (typical, atypical, mixed). Between those with typical versus atypical complaints (excluding mixed), total median proximal episodes were 11.0 (3.0-19) and 7 (2.0-17.0) and total mean proximal episodes were 18.8 +/- 26.5 and 13.5 +/- 20.3, respectively (p= 0.0694). Though not statistically significant, interestingly, results were opposite of what was expected with typical symptoms more related to increased proximal reflux events than atypical symptoms. Other parameters measured between the two groups also did not yield any significance: Total Acid Exposure Time (p=0.2044) and MNBI (p= 0.4992).
Discussion: Proximal reflux frequency had no significant correlation with atypical or typical manifestations; it cannot function as a metric to associate symptoms with GERD. However, due to lack of patients presenting with solely typical features, further research into proximal reflux frequency is warranted as more patients may push results into significance.
Kelli Liu indicated no relevant financial relationships.
Steven Clayton indicated no relevant financial relationships.
Kelli Liu, BA1, Steven Clayton, MD2. P2391 - Proximal Reflux Frequency Not Correlated With Atypical or Typical Symptoms, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.