Can symptoms predict endoscopic findings in GERD?

Gastrointest Endosc. 2003 Nov;58(5):661-70. doi: 10.1016/s0016-5107(03)02011-x.


Background: It is difficult to decide which patients with reflux symptoms require endoscopy. The aim of this study was to develop a scoring system to predict esophageal findings at endoscopy.

Methods: A consecutive sample of 1011 adult patients scheduled for upper endoscopy were asked to complete a validated symptom questionnaire. The endoscopy reports were abstracted. Individual logistic regression models were developed to predict esophagitis, Barrett's esophagus (long and short segment) and esophageal stricture, including Schatzki's ring.

Results: Reflux esophagitis was independently associated with heartburn frequency (p<0.0001) but not severity or duration (p>0.05). Barrett's esophagus was associated with the duration of acid regurgitation (p<0.005) but not with frequency or severity (p>0.05). Strictures were associated with dysphagia severity (p<0.0001) and duration (p<0.0001) but not frequency (p>0.05). At a sensitivity of 80%, the models had a specificity of 49% for esophagitis, 57% for Barrett's esophagus, and 68% for strictures. At a specificity of 80%, the sensitivities were 51% for esophagitis, 62% for Barrett's esophagus and 71% for strictures.

Conclusions: Endoscopic findings were associated with distinct attributes of reflux symptoms. Symptoms are only modestly predictive of findings at endoscopy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Barrett Esophagus / complications
  • Barrett Esophagus / diagnosis
  • Deglutition Disorders / etiology
  • Endoscopy, Digestive System*
  • Esophageal Stenosis / diagnosis
  • Esophagitis / diagnosis
  • Esophagitis, Peptic / complications
  • Female
  • Gastroesophageal Reflux / diagnosis*
  • Heartburn / etiology
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Regression Analysis
  • Sensitivity and Specificity
  • Surveys and Questionnaires