article · BMC Gastroenterology
A retrospective study in southwest Nigeria examined the relationship between symptoms and upper gastrointestinal endoscopy results in 411 patients presenting with gastro-oesophageal reflux disease. Patients were grouped by whether they reported oesophageal symptoms, extra-oesophageal symptoms, or both. Extra-oesophageal symptoms alone were the most frequent presentation, seen in over two thirds of patients, whilst chest pain and heartburn were the most common individual complaints. Patients presenting with combined symptoms were significantly younger than those with only one type. Endoscopic evaluation revealed that while under half of the patients had oesophageal injuries associated with reflux, more than sixty per cent had gastroduodenal erosions, which were the only mucosal abnormality significantly linked to symptom subtype. Other findings included peptic ulcers, candidal oesophagitis, and tumours, with normal results found in under a tenth of individuals.
Reflux symptoms do not always match what clinicians find during physical examination of the digestive tract. By demonstrating that many individuals experience atypical symptoms yet harbour substantial non-oesophageal injuries, this work underscores the clinical value of visual endoscopic assessment. It helps healthcare providers better understand symptom patterns to avoid missing serious underlying tissue damage in individuals presenting with common gastric complaints.
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BACKGROUND: Gastro-oesophageal reflux disease (GORD) presents with either oesophageal or extra-oesophageal symptoms, or both. The association between symptom subtypes and upper gastrointestinal endoscopy (UGIE) findings has been rarely studied in Nigeria. Our study aimed to determine the pattern of symptom subtypes and UGIE abnormalities, as well as their association in patients with GORD symptoms in Nigeria. METHODS: A retrospective, cross-sectional study of UGIE findings in patients with GORD from two endoscopy suites in southwest Nigeria, conducted from January 2022 to December 2023. Symptoms were categorised as oesophageal-only (OO), extra-oesophageal only (EO), or oesophageal plus extra-oesophageal (O + E). Demographic and UGIE data were compared using ANOVA, Pearson's chi-square, or Fisher's exact tests using R software. Analyses were two-tailed, and statistical significance was set at p < 0.017. RESULTS: There were 411 patients, 180 (43.8%) of whom were male, with a mean age of 45.3 years. The most frequent symptoms were chest pain (131, 31.9%) and heartburn (97, 23.6%). Overall, 280 (68.1%) of them presented with EO, 99 (24.1%) with OO, and 32 (7.8%) with O + E symptoms. Patients with O + E were younger (mean age 37.7 years) than those with OO (44.6 years) or EO (46.4 years), p = 0.008. On UGIE, gastroduodenal erosions were seen in 250 (60.8%), GORD-associated oesophageal injury in 183 (44.5%), peptic ulcer in 43 (10.5%), candidal oesophagitis in 38 (9.3%), tumour in 6 (1.5%), and normal findings in 34 (8.3%). Only gastroduodenal erosions were associated with symptom subtype. CONCLUSION: Most patients with GORD presented with extra-oesophageal symptoms. While fewer than half had reflux-associated oesophageal injury, non-oesophageal lesions were present in the majority of patients, highlighting the importance of endoscopic evaluation in patients with GORD symptoms.
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DOI: 10.1186/s12876-025-04369-x
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