Limited value of typical gastroesophageal reflux disease symptoms to screen for erosive esophagitis in Taiwanese

Background and Purpose: The predictive value of gastroesophageal reflux disease (GERD) symptoms for erosive esophagitis is controversial. This study evaluated the sensitivity of heartburn and acid regurgitation as indicators of erosive esophagitis in Taiwanese. Methods: Data collected from 521 consecutive health check-up participants who received panendoscopy and completed a self-administered questionnaire for GERD were analyzed. A classification system was used based on the presence of typical symptoms (heartburn or acid regurgitation) experienced 1 or more times per week (I), less than once per week, but more than once per month (II), and in the past (III), and in subjects free of typical symptoms, comprised those with atypical symptoms (IV), extraesophageal symptoms (V), both atypical and extraesophageal symptoms (VI), and lack of all of the above symptoms (VII). The Los Angeles classification was used for the endoscopic assessment of erosive esophagitis. Results: The sensitivity, positive predictive value (PPV), and specificity of criteria I+II were 30.5%, and 78.9%, respectively, for erosive esophagitis in Taiwanese. Inclusion of symptoms in category III increased sensitivity by 13.3%. Combined symptoms in categories IV+V+VI had the highest negative predictive value of 85.5% and a fair specificity of 73.8% for those free of typical symptoms. In the overall classification system, the combination of symptoms in categories IV+V+VI increased sensitivity by 17.9 to 61.7%, and decreased specificity by 26.3 to 40.4%. The most specific indicator was symptoms in category I (with a PPV of 45% for erosive esophagitis in symptomatic patients). About two-fifths (38.3%) of patients with erosive esophagitis had none of the symptoms in the classification system. Conclusions: Heartburn and acid regurgitation are insensitive predictors of erosive esophagitis in Taiwanese. Step-wise addition of previous typical symptoms, currently atypical and extraesophageal symptoms to the "heartburn and acid regurgitation" criterion can greatly increase sensitivity, but endoscopy remains the method of choice to detect erosive esophagitis.