Phenotyping and symptom diagnostic accuracy in unproven gastroesophageal reflux disease (GERD): An experience from Saudi GI Motility Labs
Abstract
BACKGROUND
The recent Saudi Gastroenterology Association (SGA) clinical care pathway for gastroesophageal reflux disease (GERD) recommends objective physiologic testing in patients with persistent reflux symptoms and normal endoscopy. This study aimed to phenotype patients with unproven GERD using 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring and high-resolution manometry (HRM), and to evaluate the diagnostic utility of reflux symptoms.
METHODS
In this retrospective cohort study, adult patients with reflux-like symptoms and either normal endoscopy or Los Angeles grade A esophagitis underwent off-proton pump inhibitor MII-pH monitoring and HRM, between July 2020 and September 2025. GERD phenotypes were classified as non-erosive reflux disease (NERD), reflux hypersensitivity (RH), or functional heartburn (FH) according to the Lyon Consensus v2.0 and SGA clinical care pathway guidelines. Manometric findings were interpreted using the Chicago Classification criteria. The sensitivity and specificity of typical and extra-esophageal symptoms for identifying NERD were assessed.
RESULTS
A total of 117 patients were included (median age 39 years; 53.85% male). Phenotyping identified 27.35% as NERD, 47.86% as RH, and 24.79% as FH. Symptom profiles overlapped across groups. Median acid exposure time and mean nocturnal baseline impedance showed expected physiologic gradients, with the highest acid burden and lowest impedance in NERD. Abnormal esophageal motility was…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 117 participants or records.
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