Atypical symptoms of GORD in Belgium : Epidemiological features, current management and open label treatment with 40 mg esomeprazole for one month

Frequency of atypical symptoms in patients suffering from gas- tro-oesophageal reflux disease (GORD) is not well known, and the optimal management of such symptoms has not been well estab- lished. Our aims were to set up an observatory of these atypical symptoms of GORD in Belgium and to study the efficacy of one month treatment with esomeprazole 40 mg. Patients and methods : Gastroenterologists participating in this observational survey were asked to register every new outpatient with symptoms of GORD during a period of 20 consecutive work- ing days. All patients who reported predominant presence of atyp- ical manifestations of GORD were documented and characterized more in detail. In patients with dominant chest pain or ENT symp- toms, a treatment with esomeprazole 40 mg daily during 4 weeks was proposed. Results : 90 gastroenterologists included 2864 patients consult- ing for symptoms suggestive of GORD, including 776 (27.1%) with dominant atypical symptoms. Endoscopy (performed in 2800 patients) showed significantly less oesophagitis in atypical than in typical GORD patients (68% vs. 81.1% ; P < 0.0001). Management of atypical GORD patients appeared to be very het- erogeneous. Overall 516/776 patients were included in the open phase of treatment with esomeprazole 40 mg, but data for analysis are only available in 228 patients. After one month, symptoms had disappeared in 57.1% and significantly improved in 26.6%. Conclusion : Atypical GORD represents a large number of con- sultations in gastroenterology in Belgium. It is associated with less endoscopic lesions than typical GORD. Its management is hetero- geneous reflecting the lack of guidelines on this topic. Response rate after esomeprazole 40 mg for one month in this open uncon- trolled trial was high. This result warrants confirmation in a placebo-controlled trial. (Acta gastroenterol. belg., 2006, 69, 203- 208).