Can subjective symptoms predict objective findings in gastroesophageal reflux disease patients?

Abstract

Medical therapy is thefirst-linetreatmentfor gastroesophageal reflux disease, but surgical options are available and shown to be effectivewhen medical management fails.There is no consensus for whena surgical evaluation is indicated.We set out todetermine if the GERD-HRQLquestionnaire scorescorrelateto objective findingsfound inpatients undergoing anti-reflux surgerytopredictwhen surgical consultation could be warranted. A prospectively gathered database was used for patientsundergoing anti-reflux surgery from January 2014 to September 2020. Inclusion criteria required a diagnosis of GERD and comprehensive esophageal workup with the GERD-HRQL questionnaire, EGD, esophageal manometry, and ambulatory pH monitoring.Analysis of the GERD-HRQL scores was compared to objective endpoints to see correlation and predictability.Logistic regression analysis was used to assess relationship between the presence ofobjective findingsand GERD-HRQLquestionnairescores. There were 246 patients meeting inclusion criteria. There was no significant correlation between GERD-HRQLscore and DeMeester score(correlation coefficient = 0.23), or presence of a hiatal hernia, regardless of size(p = 0.89). Patients with esophagitis had significantly higher average GERD-HRQL scores compared to those without esophagitis(40.1 ± 18.9 vs 30.4 ± 19.1, p < 0.0001). Patients with a score of 40 or greater had a42% to 65%probability of having esophagitis versus a score of 30 or less, lowering the chances of having esophagitis to less than35%. Usage of a GERD-HRQLquestionnairescore can potentially show the correlation between subjective and objective findings in the workup of a patient for anti-reflux surgery. Specifically, patients with a GERD-HRQL score of 40 or greater have an increased probability of esophagitis compared to those with a score of 30 or less. Using these scores can help referring clinicians identify those patients failing medical therapy and allow for promptreferral for surgical evaluation.