Incomplete Response of Gastroesophageal Reflux Symptoms Poorly Predicts Erosive Esophagitis or Barrett’s Esophagus

ABSTRACT Background and Aims Many patients with symptoms of gastroesophageal reflux disease (GERD) not responding to proton pump inhibitor (PPI) undergo upper endoscopy. We hypothesized that incomplete response to PPI is not associated with findings of esophageal pathology on endoscopy, and that psychological distress is inversely associated with pathology. Methods We enrolled consecutive individuals aged 40-79 with prior heartburn or regurgitation. Logistic regression was used to estimate the effects of incomplete response of GERD symptoms and psychological distress on the odds of finding erosive esophagitis or Barrett’s esophagus. Results 625 patients completed the study. 254 (66.8% of those taking PPI) had GERD symptoms incompletely responsive to PPI and 352 (56.3%) had severe somatization. Incomplete response to PPI was associated with psychological distress (p Conclusion Patients undergoing upper endoscopy frequently have GERD symptoms incompletely responding to PPI and a high burden of somatization. However, incomplete response of GERD symptoms is a poor predictor for endoscopic pathology, and should not be relied upon for selecting patients for screening for Barrett’s esophagus. Patients with high psychological distress are less likely to have esophageal pathology.