GERD presentation not always by the book

Medical Tribune September 2008 SFV
David Brill


Doctors should be more wary of atypical
presentations of gastro-esophageal reflux
disease (GERD), a Singapore specialist
advised recently.
Although the classical symptoms are easily
recognizable, some 10 percent of patients
will not fulfill the usual criteria for GERD,
said Dr. Lui Hock Foong, chairman of the
National Foundation for Digestive Diseases.
These patients may present with coldlike
symptoms such as a sore throat, hoarse
voice or rhinitis. A chronic cough, particularly
occurring at night, can also be a sign
of GERD, and is thought to result from the
irritation of cough receptors at the lower
end of the esophagus.
Alternatively patients may have atypical
chest pain, prompting the physician to
carry out cardiac testing. If these results
come back negative, Lui said, it is possible
that the symptoms would respond to GERD
treatment.
Lui, a consultant gastroenterologist at
Gleneagles Hospital, said that knowledge
of these issues among GPs was beginning to
increase following an active campaign by the
Gastroenterological Society of Singapore to
educate about the symptoms of the disease.
He was speaking at the country’s first national
GERD awareness day on 20th August.
The condition was traditionally thought
to result from Western diets but appears to
be increasingly common in Asia. In Singapore
the prevalence rose from 1.6 to 9.9 percent
between 1994 and 1999. [J Gastroenterol
Hepatol 2005 Jul;20:995-1001]
Doctors who are faced with a possible
case of GERD should first take the time to
rule out other conditions, Lui said. Once the
diagnosis is confirmed the physician should
assess the severity of the problem using investigations
such as endoscopy, and should
check for long-term complications such as
alterations to the esophageal lining which
can predispose patients towards cancer.
A survey announced on the same day
found that public awareness of GERD is
low, with 76 percent of those who had experienced
symptoms admitting that they
had not heard of the condition. Only 42 percent
had sought treatment in the past, and
a quarter of these had waited more than a
year before doing so.
Two hundred and four people aged 25 to
60 with a history of GERD symptoms took
part in the survey. The awareness campaign
also included the distribution of a “call to
action” postcard, listing six simple steps to
help patients discuss their symptoms with
their doctor.