Are Troublesome GERD-Related Symptoms Reflecting Characteristics of the Disease or the Patient?

Abstract

Purpose: Definition of gastroesophageal reflux disease (GERD) is a debatable issue. It has been proposed that typical symptoms are constitutive of GERD if they are considered by the subjects as “troublesome” (Montreal Consensus). However, it is unknown to what extent reporting symptoms as troublesome is dependent on characteristics of subjects or symptoms themselves, and what are the differences between symptoms reported as troublesome and not, both in symptomatic subjects with and without PPI treatment. Our aim was to evaluate the differences between troublesome (TS) and non troublesome symptoms (NTS) and wich are the factors associated with TS in primary care subjects. We also aim to evaluate what the factors are associated with persistent GERD (persistence of TS) despite PPI therapy. Methods: Design: multi-centric cross-sectional survey. Patients attending Primary care centres in Spain consulting with heartburn or acid regurgitation were recruited. All of them completed a set of questionnaires, including a question to self-define their symptoms as TS or NTS (“Do you consider your heartburn and/or regurgitation symptoms as troublesome?”). Frecuency of symptoms was collected using the RDQ and GIS questionnaires. Data regarding sociodemographic variables, comorbidities, co-medications and treatment (drug and doses) were collected by the primary care physician. A logistic regression model was constructed to predict the presence of TS in patients without PPI therapy. Another logistic regression model was contructed to assess factors associated with TS under PPI treatment. Results: 4,574 patients were included; 1,887 without previous PPI treatment and 2,596 on PPI treatment. Among those without PPI treatment, 1,650 reported their symptoms as troublesome, while 237 did not. Patients with TS were slightly older, male gender was more frequent, and a higher proportion suffered from hypercholesteremia. In the regression model to predict TS, all the variables were symptom-related except hypercolesteloremia: frequency of regurgitation, frequency of epigastric burning pain, and frequency of sleeping problems. Of those on PPI treatment, 2,596 reported TS and 238 did not. There were not differences between patients with TS and TNS in subject's related factors, but smoking. In the regression model, factors associated with TS on PPI therapy were all symptom-related: frequency of regurgitation and frequency of sleeping problems. Conclusion: The symptom perception as troublesome depended mostly on the characteristic of the symptoms, especially the frequency of acid regurgitation and nocturnal symptoms. The same variables are considered as predictive factors of TS symptoms in naïve patients and patients under PPI treatment.