Causes of clinical misdiagnosis of gastroesophageal reflux disease in three patients

GE Qiaobin; HONG Shiying; XU Hongyang

doi:10.3969/j.issn.1002-3429.2025.23.002

Abstract：Objective To analyze the causes of clinical misdiagnosis of gastroesophageal reflux disease(GERD)and the methods for correcting misdiagnosis,in order to improve the diagnosis and treatment level of clinicians.Methods The clinical data of 3 patients with initially diagnosed angina pectoris and finally diagnosed GERD in our hospital from June 2021 to June 2024 were retrospectively analyzed.Results One patient was hospitalized because of intermittent irregular chest pain for 8 years that was aggravated for 1 week.The patient had a history of hypertension and diabetes,and the physical examination revealed no abnormality.The electrocardiogram(ECG)during the non-acute phase revealed T-wave flattening and inversion in the anterior leads.The initial diagnosis was coronary heart disease(CHD)with angina pectoris,and the symptoms were not improved but even aggravated after symptomatic treatment for 1 month.The upper limit of left ventricular wall thickness and the impaired left ventricular diastolic function were detected by echocardiography.Coronary CT angiography revealed no significant abnormality,and electronic gastroscopy indicated patchy or linear redness and erosion in the lower esophageal mucosa;pH testing confirmed a diagnosis of acid reflux esophagitis.The patient was diagnosed as GERD,and the misdiagnosis lasted 34 d.Proton pump inhibitors combined with gastrointestinal motility promoting agents and Hydrotalcite tablets were used.The clinical symptoms and signs disappeared at 2 months after treatment,and no recurrence was reported at 6-month follow-up.One patient was hospitalized for chest tightness and chest pain with acid regurgitation for 3 months that was aggravated for 4 d.ECG revealed T-wave inversion in leads V3-V5,and echocardiography indicated left ventricular hypertrophy and left ventricular wall thickening.The initial diagnosis was CHD with angina pectoris.However,symptoms persisted after symptomatic treatment,and ECG recordings during episodes of symptoms showed no abnormalities.Electronic gastroscopy showed strip hyperemia and erosion of the lower esophageal mucosa,and the patient was diagnosed with GERD.The misdiagnosis lasted 4 d.Rabeprazole enteric coated tablets and Mosapride tablets were given for 4 weeks,the chest pain was relieved,the signs of gastroscopy reflux disappeared,and the esophageal mucosa returned to normal.The patient was cured and discharged.One patient was hospitalized due to dizziness,palpitation and chest pain for 6 d,with a history of diabetes.ECG showed sinus rhythm,with T-wave changes in leads V1 through V4.The initial diagnosis was CHD with angina pectoris.After symptomatic treatment,the symptoms were not significantly improved,and no abnormality was detected in ECG recordings during episodes of symptoms.Gastroscopy showed strip hyperemia and erosion of the lower esophageal mucosa,and GERD was diagnosed.The misdiagnosis lasted 5 d.After diagnosis,the patients were treated with proton pump inhibitors and gastrointestinal motility drugs,and the follow-up gastroscopy revealed complete resolution of the previous findings at 4 weeks.There was no recurrence at 3-months follow-up.Conclusion The main reason why GERD is misdiagnosed as CHD with angina pectoris is that the initial symptom of such patients is chest pain;therefore,patients with chest pain should be comprehensively analyzed.For those with symptoms such as acid reflux and heartburn,the possibility of GERD should be considered,and proton pump inhibitor experimental treatment should be carried out promptly.If conditions permit,gastroscopy and other examinations should be carried out in time to reduce the occurrence of misdiagnosis.