Digest
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Although the management of heartburn is usually straightforward, patients presenting with dyspepsia without reflux symptoms are more difficult because in most cases routine investigations, including endoscopy, are normal. The underlying pathophysiology in such "functional dyspeptics" includes visceral hypersensitivity, impaired accommodation, and delayed gastric emptying. The current study examined these mechanisms in 247 such patients who also underwent 24 hour pH monitoring. While the majority (75%) had normal (<5%) oesophageal acid exposure, 58 (25%) showed significant reflux. However, 34 out of the 58 denied any reflux symptoms. There were no differences in sensitivity, accommodation, or emptying between those with or without pathological acid reflux. Considering all 247 patients the best symptom discriminator proved to be "moderate or severe epigastric pain" found in 40/58 with acid reflux versus 91/189 in those without. The conclusion is that a trial of therapy for reflux is rational for epigastric pain, even if the patient denies
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