P232 Excessive belching in GERD: supragastric belching or small intestinal bacterial overgrowth?

Abstract

proximal oesophagus. Its importance as a cause of throat symptoms has been recognised, particularly chronic globus.Studies report variable figures regarding the prevalence of heterotopic gastric mucosa in the proximal oesophagus, between 0.03% and 5.9%. It is likely that this variability is due to the quality of endoscopy, with one study demonstrating the detection rate rises 10-fold when endoscopists were aware of the condition.Here, we aimed to evaluate the true prevalence of cervical inlet patch in patients with and without globus following implementation of a structured endoscopy reporting template to enhance detection rate of CIP. Methods A prospective study of presence of inlet patch documented during endoscopic BRAVO capsule procedures performed between 2009 and 2020 was undertaken. Five operators carried out the procedures with expertise in optical image enhancement endoscopy and upper-GI lesion recognition. Endoscopy reports were interrogated including picture photo-documentation to confirm presence of inlet patch. Additionally, patient symptoms and BRAVO capsule pH data were analysed to detect association with globus and reflux. Assessment of normality of data was assessed using the Shapiro Wilks test and subsequently non-parametric analyses were performed using the Mann Whitney U test. Results A total of 1042 patients undergoing Bravo were studied. The use of a structured endoscopy reporting template for BRAVO capsule was used and as such all patients were classified as having the presence or absence of an inlet patch.All had conscious sedation; median dose of fentanyl 100 mcg (75-150 mcg) and midazolam 4 mg (3-7 mg).CIPs were detected in 76/1042 (7.1%). Association of CIP and abnormal BRAVO reading was non-significant for number of reflux events or total acid exposure time but was significantly associated with symptoms such as chest pain (p<0.05).In those with no globus symptoms (n=294), CIP was detected in 13 (4.4%), but in those with globus (n=748), this increased to 63 (8.4%), p=0.03. Conclusions In this large cohort study the prevalence of cervical inlet patch was found to be 7%, and in those with oropharyngeal symptoms, over 8%. Improved detection rate may be related to numerous factors, including endoscopists level of experience at detecting pathology, sedation use and patient comfort, as well as a reporting template focusing the endoscopist to comment on presence/absence of inlet patch. Presence of CIP may be considered as a quality metric of upper-GI endoscopy in the future.