Fabio Pace1*, Marina Pace2 and Edoardo Savarino3
1Department of Clinical Sciences, Division of Gastroenterology and Digestive Endoscopy, “Bolognini” Hospital, Italy
2Department of Imaging, Radiology Unit, Hospital Papa Giovanni XXIII, Italy
3Department of Surgical, Gastroenterology Unit, Oncological and Gastroenterological Sciences, University of Padua, Italy
Gastroesophageal Reflux Disease (GERD) is a common problem, with a prevalence ranging between 10% and 20% according to the geographic area, which is expensive to diagnose and treat in both primary and tertiary care settings. Diagnosing GERD poses many problems: firstly, gastroesophageal reflux may be a physiologic phenomenon, and hence a quantitative and not qualitative test is needed. Secondly, symptoms are rather unspecific and it may be difficult to link them to GERD, particularly in the setting of extraesophageal manifestations. Endoscopy is very useful when complications are found, namely erosions, ulcers or Barrett’s metaplastic epithelium, yet the majority of patients with GERD have a Negative Endoscopy (so called NERD) despite typical symptoms. Esophageal 24h pH-monitoring and pH-impedance examinations have greatly increased the diagnostic yield, but they are not universally available and are quite expensive. Finally a PPI test may be attractive in the setting of general practitioner, but its sensitivity and specificity are rather poor. In conclusion, we still face a disease which has only imperfect ways of truly being diagnosed.
Pace F, Pace M, Savarino E. Gastro Esophageal Reflux Disease: An Imperfect Diagnosis. J Gastroenterol Hepatol Endosc. 2018;3(2):1044.