Current Gastroenterology Reports

, Volume 8, Issue 3, pp 195–201 | Cite as

Clinical consequences of silent gastroesophageal reflux disease

  • Ronnie FassEmail author
  • Ram Dickman


Silent gastroesophageal reflux disease (GERD) is a very common phenomenon that involves the incidental finding of erosive esophagitis, Barrett’s esophagus, and the evolution of esophageal adenocarcinoma in asymptomatic patients. The reasons for having advanced GERD without clearly identifiable symptoms are poorly understood, primarily due to lack of recognition of this important phenomenon. The clinical implications of silent GERD are vast and should provide the impetus for further research into this group of patients. Recent studies have suggested that sleep disturbances and poor quality of sleep could be the needed clues to identify individuals with silent GERD.


Transient Receptor Potential Vanilloid Esophageal Adenocarcinoma Acid Exposure GERD Symptom GERD Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Locke GR, III, Talley NJ, Fett SL, et al.: Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County,Minnesota. Gastroenterology 1997, 112:1448–1456.PubMedCrossRefGoogle Scholar
  2. 2.
    Ismail-Beigi F. Histological evaluation of esophageal mucosa in reflux esophagitis [letter]. Gastroenterology 1975, 69:569–570.PubMedGoogle Scholar
  3. 3.
    Cameron AJ, Ott BJ, Payne WS: The incidence of adenocarcinoma in columnar-lined (Barrett’s) esophagus. N Engl J Med 1985, 313:857–859.PubMedCrossRefGoogle Scholar
  4. 4.
    Lagergren J, Bergstrom R, Lindgren A, et al.: Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999, 340:825–831.PubMedCrossRefGoogle Scholar
  5. 5.
    Barrett’s esophagus: epidemiological and clinical results of a multicentric survey. Gruppo Operativo per lo Studio delle Precancerosi dell’Esofago (GOSPE). Int J Cancer 1991, 48:364–368.Google Scholar
  6. 6.
    Cameron AJ, Zinsmeister AR, Ballard DJ, et al.: Prevalence of columnar-lined (Barrett’s) esophagus. Comparison of population-based clinical and autopsy findings. Gastroenterology 1990, 99:918–922.PubMedGoogle Scholar
  7. 7.
    Gerson LB, Shetler K, Triadafilopoulos G: Prevalence of Barrett’s esophagus in asymptomatic individuals. Gastroenterology 2002, 123:461–467.PubMedCrossRefGoogle Scholar
  8. 8.
    Rex DL, Cummings OW, Shaw M, et al.: Screening for Barrett’s esophagus in colonoscopy patients with and without heartburn. Gastroenterology 2003, 125:1670–1677. A well-done study demonstrating the prevalence rate of silent erosive esophagitis in asymptomatic and silent Barrett’s esophagus in subjects undergoing screening colonoscopy for colorectal cancer.PubMedCrossRefGoogle Scholar
  9. 9.
    Sanfey H, Hamilton SR, Smith RR, et al.: Carcinoma arising in Barrett’s esophagus. Surg Gynecol Obstet 1985, 161:570–574.PubMedGoogle Scholar
  10. 10.
    Ecclissato C, Carvalho AF, Ferraz JG, et al.: Prevalence of peptic lesions in asymptomatic, healthy volunteers. Dig Liver Dis 2001, 33:403–406.PubMedCrossRefGoogle Scholar
  11. 11.
    Akdamar K, Ertan A, Agawal NM, et al.: Upper gastrointestinal endoscopy in normal asymptomatic volunteers. Gastrointest Endosc 1986, 32:78–80.PubMedCrossRefGoogle Scholar
  12. 12.
    Fass R, Sampliner RE, Mackel C, et al.: Age- and genderrelated differences in 24-hour esophageal pH monitoring of normal subjects. Dig Dis Sci 1993, 38:1926–1928.PubMedCrossRefGoogle Scholar
  13. 13.
    Fass R, Sampliner RE: Case report: Barrett’s esophagus and other mucosal evidence in reflux in asymptomatic subjects with abnormal 24-hour esophageal pH monitoring. Dig Dis Sci 1994, 39:423–425. One of the early reports about silent reflux in asymptomatic group of subjects. The study also provides information about the extent of abnormal esophageal acid exposure in subjects without GERDrelated symptoms.PubMedCrossRefGoogle Scholar
  14. 14.
    Lehmann FS, Renner EL, Meyer-Wyss B, et al.: Helicobacter pylori and gastric erosions. Results of a prevalence study in asymptomatic volunteers. Digestion 2000, 62:82–86.PubMedCrossRefGoogle Scholar
  15. 15.
    Ronkainen J, Aro P, Storskrubb T, et al.: High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report. Scand J Gastroenterol 2005, 40:275–285. One of the largest reports about silent GERD in the general population. The study provides prevalence rates of silent erosive esophagitis and silent Barrett’s esophagus in two Swedish municipalities.PubMedCrossRefGoogle Scholar
  16. 16.
    Ronkainen J, Aro P, Storskrubb T, et al.: Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology 2005, 129:1825–1831.PubMedCrossRefGoogle Scholar
  17. 17.
    Fass R, Fennerty MB, Vakil N: Nonerosive reflux disease: current concepts and dilemmas. Am J Gastroenterol 2001, 96:303–314.PubMedGoogle Scholar
  18. 18.
    Fass R, Naliboff B, Higa L, et al.: Differential effect of long-term esophageal acid exposure on mechanosensitivity and chemosensitivity in humans. Gastroenterology 1998, 115: 1363–1373.PubMedCrossRefGoogle Scholar
  19. 19.
    Marrero JM, de Caestecker JS, Maxwell JD: Effect of famotidine on oesophageal sensitivity in gastro-oesophageal reflux disease. Gut 1994, 35:447–450.PubMedGoogle Scholar
  20. 20.
    Ferreira KT, Hill BS: The effect of low external pH on properties of the paracellular pathway and junctional structure in isolated frog skin. J Physiol 1982, 332:59–67.PubMedGoogle Scholar
  21. 21.
    Hopwood D, Milne G, Logan KR: Electron microscopic changes in human oesophageal epithelium in oesophagitis. J Pathol 1979, 129:161–167.PubMedCrossRefGoogle Scholar
  22. 22.
    Tobey NA, Carson JL, Alkiek RA, et al.: Dilated intercellular spaces: a morphological feature of acid reflux-damaged human esophageal epithelium. Gastroenterology 1996, 111:1200–1205.PubMedCrossRefGoogle Scholar
  23. 23.
    Orlando RC: Pathophysiology of gastroesophageal reflux disease. In Esophagus, edn 3. Edited by Castell DO, Richter JE. Philadelphia: Lippincott Williams & Wilkins; 1999:409–419.Google Scholar
  24. 24.
    Kern MK, Birn RM, Jaradeh S, et al.: Identification and characterization of cerebral cortical response to esophageal mucosal acid exposure and distention. Gastroenterology 1998, 115:1353–1362.PubMedCrossRefGoogle Scholar
  25. 25.
    Martinez SD, Malagon I, Garewal HS, et al.: Non-erosive reflux disease (NERD) - is it really just a mild form of gastroesophageal reflux disease (GERD) [abstract]? Gastroenterology 2001, 120:A-424.CrossRefGoogle Scholar
  26. 26.
    Meyer JH, Lembo A, Elashoff JD, et al.: Duodenal fat intensies the perception of heartburn. Gut 2001, 49:624–628.PubMedCrossRefGoogle Scholar
  27. 27.
    Fass R: Focused clinical review: Nonerosive reflux disease. Medscape Gastroenterol 2001, 3:1–13.Google Scholar
  28. 28.
    Trimble KC, Pryde A, Heading RC: Lowered oesophageal sensory thresholds in patients with symptomatic but not excess gastro-oesophageal reflux: evidence for a spectrum of visceral sensitivity in GORD. Gut 1995, 37:7–12.PubMedGoogle Scholar
  29. 29.
    Mayer EA: Spinal and supraspinal modulation of visceral sensation. Gut 2000, 47:iv69–72, discussion iv76.PubMedGoogle Scholar
  30. 30.
    The Gallup Organization: A Gallup Survey on Heartburn Across America. Princeton, NJ: Gallup; 1988.Google Scholar
  31. 31.
    Cook IJ, Collins SM: Does acute emotional stress influence frequency or duration of gastroesophageal reflux in human subjects? Gastroenterology 1986, 90:1380.Google Scholar
  32. 32.
    Bradley LA, Richter JE, Pulliam TJ, et al.: The relationship between stress and symptoms of gastroesophageal reflux: the influence of psychological factors. Am J Gastroenterol 1993, 88:11–19.PubMedGoogle Scholar
  33. 33.
    McDonald-Haile J, Bradley LA, Bailey MA, et al.: Relaxation training reduces symptom reports and acid exposure in patients with gastroesophageal reflux disease. Gastroenterology 1994, 107:61–69.PubMedGoogle Scholar
  34. 34.
    Richter JE, Bradley LA. Psychophysiological interactions in esophageal diseases. Semin Gastrointest Dis 1995, 7:169–184.Google Scholar
  35. 35.
    Fass R, Malagon I, Naliboff B, et al.: Abstract: Effect of psychologically induced stress on symptom perception & autonomic nervous system response of patients (PTS.) with erosive esophagitis (EE) and non-erosive reflux disease (NERD) [abstract] Gastroenterology 2000, 118:A637.CrossRefGoogle Scholar
  36. 36.
    Chan CL, Facer P, B DJ, et al.: Sensory fibres expressing capsaicin receptor TRPV1 in patients with rectal hypersensitivity and faecal urgency. Lancet 2003, 361:385–391.PubMedCrossRefGoogle Scholar
  37. 37.
    Matthews PJ, Aziz Q, Facer P, et al.: Increased capsaicin receptor TRPV1 nerve fibres in the inflamed human oesophagus. Eur J Gastroenterol Hepatol 2004, 16:897–902.PubMedCrossRefGoogle Scholar
  38. 38.
    Szallasi A, Blumberg PM. Vanilloid (Capsaicin) receptors and mechanisms. Pharmacol Rev 1999, 51:159–212.PubMedGoogle Scholar
  39. 39.
    El-Serag HB, Garewal H, Kuebeler M, et al.: Is the length of newly diagnosed Barrett’s esophagus decreasing? The experience of a VA Health Care System. Clin Gastroenterol Hepatol 2004, 2:296–300.PubMedCrossRefGoogle Scholar
  40. 40.
    Fass R, Shapiro M, Dekel R, et al.: Systematic review: proton-pump inhibitor failure in gastro-oesophageal reflux disease—where next? Aliment Pharmacol Ther 2005, 22:79–94.PubMedCrossRefGoogle Scholar
  41. 41.
    Dimenas E: Methodological aspects of evaluation of Quality of Life in upper gastrointestinal diseases. Scand J Gastroenterol 1993, 199:18–21.Google Scholar
  42. 42.
    Fass R: Distinct phenotypic presentations of gastroesophageal reflux disease: a new view of the natural history. Dig Dis 2004, 22:100–107.PubMedCrossRefGoogle Scholar
  43. 43.
    Dickman R, Green C, Quan SF, et al.: The effect of poor quality of sleep on esophageal acid exposure [abstract]. Gastroenterology, in press.Google Scholar
  44. 44.
    Orr WC: Heartburn: another danger in the night [editorial]? Chest 2005, 127: 1486–1488.PubMedCrossRefGoogle Scholar
  45. 45.
    Dekel R, Green C, Malagon I, et al.: Short, spontaneous, anamnestic arousals are the most common sleep abnormality associated with nocturnal esophageal acid exposure [abstract]. Gastroenterology 2003, 1254:A-412.Google Scholar
  46. 46.
    Orr WC, Goodrich S, Sturgeon R, et al.: "Silent "gastroesophageal reflux in patients with unexplained sleep complaints [abstract]. Am J Gastroenterol 2005, 100: S50-S51. An interesting abstract raising the possibility that sleep abnormalities could serve as the needed clue for diagnosing silent GERD.Google Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.GI Section (1-11G-1)Southern Arizona VA Health Care SystemTucsonUSA

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