Endoscopy-negative acid reflux disease

Abstract

Recent clinical trials have yielded important new information about endoscopy-negative acid reflux disease. Patients with this disease tend to be younger than those with endoscopy-positive disease and are more likely to be female, thin and without hiatal hernia. The trials have shown that, in patients with endoscopy-negative reflux disease, symptoms (particularly heartburn) tend to be less severe and less frequent than in patients with endoscopy-positive disease. The overlap between the groups is such, however, that the symptoms cannot be used to distinguish reflux patients with oesophagitis from those without. Approximately 50% of patients with endoscopy-negative disease were found to have levels of oesophageal acid exposure that fell within the normal range. Oesophageal pH monitoring is therefore of limited value in patients with endoscopy-negative reflux disease, unless the test focuses on analysis of the correlation between symptoms and episodes of reflux. New studies have also made clear, for the first time, that endoscopy-negative acid reflux disease has a measurable and substantial impact on the patients' general well-being and quality of life. Patients with endoscopy-negative disease have quality-of-life scores that are similar to those found in patients with oesophagitis.