Retrosternal Burning and Its Endoscopic Associations: Findings from 5,561 Upper Gastrointestinal Endoscopies

Retrosternal burning is often linked to gastroesophageal reflux disease. However, it can also indicate other gastrointestinal disorders. This study aimed to compare and assess upper gastrointestinal (UGI) endoscopic findings in patients with and without retrosternal burning to determine its clinical significance.

This cross-sectional study analyzed data from 5,561 patients who underwent UGI endoscopy in Khorramabad, Iran (2018-2023). Required data, such as demographics, clinical symptoms, and endoscopic diagnoses, including the grade and severity of esophagitis and sliding hiatal hernia, were collected and compared. Statistical significance was set at P<0.05.

Of the patients, 57.08% were women. The most common indications for endoscopy were dyspepsia and retrosternal burning. Sliding hiatal hernia (49.73%), esophagitis (60.04%), and antral gastropathy (76.53%) were the most frequent endoscopic findings. Grade 2 was the most prevalent type in patients with hernias (74.80%), and among patients with esophagitis, Grade A was predominant (87.36%). Retrosternal burning showed a significant positive association with sliding hiatal hernia, esophagitis, gastric antral gastropathy, and inlet patches (P<0.001). In contrast, the absence of retrosternal burning was associated with gastric ulcers, gastric and esophageal masses (P<0.001), duodenal ulcers (P=0.037), and bulb deformities (P=0.015). A significant association was found between retrosternal burning and the severity of both sliding hiatal hernia and esophagitis (P<0.001).

Retrosternal burning was frequently observed in patients with certain UGI structural abnormalities, such as sliding hiatal hernia and esophagitis, suggesting a possible association. Based on the findings of the present study, a more comprehensive diagnostic approach might be warranted for patients presenting with retrosternal burning to evaluate them for potential structural abnormalities.