Accuracy of the Diagnosis of GORD by Questionnaire, Physicians and a Trial of Proton Pump Inhibitor Treatment: The Diamond Study (Gut 2010;59:714-721)

Abstract

Dent et al1 reported a study entitled Accuracy of the diagnosis of GORD by questionnaire, physicians and a trial of proton pump inhibitor treatment: The Diamond Study in the June 2010 issue of Gut. Patients with symptoms considered by their family practitioner to be of upper gastrointestinal origin were enrolled from 6 countries (n = 308). The Reflux Disease Questionnaire (RDQ) was completed and a symptom-based diagnosis was made by the family practitioner.2 Placebo esomeprazole was started after the diagnosis. Gastroenterologists made a symptom-based diagnosis and then performed endoscopy and wireless 48 hour esophageal pH recordings with monitoring of associated symptoms; the findings were used to determine the reference standard for the presence or absence of gastroesophageal reflux disease (GERD). Symptoms were recorded during treatment with 40 mg of esomeprazole for 2 weeks. The main outcome measure was RDQ scoring for the presence of GERD compared to the symptom-based diagnosis by family physicians and gastroenterologists. GERD was present in 203/308 (66%) of the patients. Only 49% of the patients with GERD reported either heartburn or regurgitation as their most troublesome symptom. The sensitivity and specificity of the symptom-based diagnosis of GERD, were 62% and 67% for the RDQ, 63% and 63% for the family practitioners, 67% and 70% for the gastroenterologists and 54% and 65% for the 2-week trial of proton pump inhibitor (PPI) treatment. The symptom-based diagnosis of GERD by the RDQ, family practitioners and gastroenterologists had moderate and similar accuracy. Symptom response to a 2-week course of 40 mg of esopmeprazole did not increase the diagnostic accuracy.