Original Article J. Clin. Biochem. Nutr., 46, 229–233, May 2010 BtjJ01KOchoC098bryeu.18Bino3grS20N0tn1i-on9a605,cal-40iJl9o/e08aj6Atfcp96ybCratfniloci.0nrle9iFc-rat9eli6eBoRinoacdhinceamlgiRstebryseyanrcdNhNJuuaptraitnsioinng rief Ques i r Staffs before Endoscopic Examination May Not Always Pick Up Clinical Symptoms of Endoscopic Reflux Esophagitis Tooru Takashima1,2,*, Kanako Yamaguchi1, Megumi Hara3, Tomoko Fukuda4, Tsukasa Kuroki1, Chie Furushima2, Ruriko Wakeshima2, Ryuichi Iwakiri1, Kazuma Fujimoto1 and Norie Inoue2 1Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, 5-1-1, Nabeshima, Saga 849-8501, Japan 2Department of Basic Science for Nursing, Saga Medical School, 5-1-1, Nabeshima, Saga 849-8501, Japan 3Department of Preventive Medicine, Saga Medical School, 5-1-1, Nabeshima, Saga 849-8501, Japan 4Nursing Section of Saga Medical School Hospital, 5-1-1, Nabeshima, Saga 849-8501, Japan ;52143R602aec126cc0eeivpetedd1258.1.102.2.2000099 Received 15 October, 2009; Accepted 28 December, 2009; Published online 10 April, 2010 CopySriugmhtm©a2r0y10TJChBeNclinical features of patients reflux esophagitis without any symptoms have not been clearly demonstrated. This study evaluated the clinical features of patients with endoscopy- positive reflux esophagitis, who did not complain of symptoms, as detected by brief questioning by nursing staffs. Eight thousand and thirty-one patients not taking medication for gastro- intestinal disease, were briefly asked about the presence of heartburn, dysphagia, odynophagia and acid regurgitation by nursing staffs before endoscopy for assessment of esophagitis utiliz- ing the Los Angeles Classification. Endoscopically, 1199 (14.9%) patients were classified as positive for reflux esophagitis. The endoscope positive subjects who complain heartburn were 539/1199 (45.0%).The endoscope positive subjects who do not complain symptoms were 465 in 1199 positive reflux esophagitis (38.8%). We compared endoscopic positive subjects without any complain by brief question by nursing staffs to endoscopic positive subjects with heartburn. Male gender, no obesity, absence of hiatus hernia, and low-grade esophagitis were associated with endoscopy-positive patients who do not complain of symptoms. The results of this study indicated correct detection of clinical symptoms of reflux esophagitis might be not easy with brief questioning by nursing staffs before endoscopic examination. Key Words: Loss Angeles Classification, gastroesophageal reflux disease, heartburn Introduction Gastroesophageal acid reflux causes a variety of clinical symptoms, such as heartburn, acid regurgitation, dysphagia and retrosternal pain. These reflux symptoms show varying severity, frequency and incidence [1]. Endoscopic evalua- tion is a reliable method for evaluation of esophagitis [1, 2] and the Los Angeles Classification is one of the most *To whom correspondence should be addressed. Tel: +81-952-34-2351 Fax: +81-952-34-2017 E-mail: taka2000225ns@ybb.ne.jp 229 accepted grading systems for esophageal mucosal breeches [2, 3]. It is widely accepted that such typical clinical symp- toms of gastroesophageal reflux reflect the presence and grading of endoscopic reflux esophagitis. Clinical symptoms might vary between countries and races [4, 5], and several studies from Japan have indicated a relationship between symptoms and reflux esophagitis [6–17]. Our coworkers have previously indicated that clinical symptoms detected by short questions before endoscopic examination were not always equivalent to grading of reflux esophagitis, espe- cially regarding dysphagia, in a cross-sectional study of 8031 subjects [8, 18]. The present study aimed to assess limitation of brief asking of symptoms before endoscopic