Towards better understanding of symptoms associated with disordered esophageal function

Gastroesophageal reflux disease (GERD) is one of the most common disorders of the gastrointestinal tract. It is characterized by both typical symptoms (heartburn and regurgitation) but also atypical symptoms which include cough, chest pain and dysphagia. This thesis aimed to address current topics in the field of gastroesophageal reflux disease, reflux-related chronic cough, and non-cardiac chest pain and dysphagia. Our investigations were prompted by the impression that there are overlaps and interrelationships between the disorders which would merit further investigation.
In the first part of the thesis we demonstrate the importance of distinguishing patients with non-erosive reflux disease from patients with functional heartburn. We also show that running leads to a significant increase in esophageal acid exposure in healthy volunteers and we look into the underlying mechanisms. In the second part of this thesis we evaluate patients with chronic unexplained cough and we assess the underlying pathophysiological mechanisms. Moreover, we evaluate 24-hour pH-impedance-pressure monitoring as a diagnostic tool in these patients and whether a two-minute interval can be used to determine the presence of an association. In the last part of the thesis we evaluated patients with non-cardiac chest pain and patients with dysphagia. We show the importance of 24-hour manometry in non-cardiac chest pain patients and evaluate what reflux characteristics are important in perceiving a reflux episode as chest pain. Moreover, we assessed patients with jackhammer esophagus and patients with unexplained non-obstructive esophageal dysphagia.