Frequent Nocturnal Complaints of Heartburn and Acid Regurgitation Are Associated with Higher GERD Severity Scores

Abstract

Purpose: To assess the relationship between frequent nighttime symptoms of gastroesophageal reflux disease (GERD) and patient perception of GERD severity. Methods: A general population of US adults participated in a web survey, which included the GERD Symptom & Medication Questionnaire (GERD-SMQ), a validated GERD screener. Frequency and severity of nighttime and daytime heartburn and acid regurgitation during the previous 3 months were each assessed. Nighttime GERD (NTG) cases were defined as: (a) ≥2 nights/week with symptoms, or (b) <2 nights/week with symptoms but no daytime symptoms. Daytime GERD (DTG) cases were GERD cases not satisfying NTG criteria. The highest value from the nighttime heartburn and acid regurgitation severity ratings was used as the severity score for each NTG case, and the highest from the two daytime ratings was used for each DTG case. Severity classification was: mild (1–4), moderate (5–7) and severe (8–10). Results: 2805 of 18213 invited to participate responded. 2603 satisfied the study criteria (mean age = 46 years, 55% women). Among GERD cases with current symptoms (n = 668), 303 (45%) met criteria for NTG. 33% of NTG cases were severe compared with 9% of the DTG group (see table). The odds of having moderate GERD symptoms as opposed to mild symptoms were 2.1 times greater among those with NTG compared with DTG) (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 1.4, 3.1). The odds increased 8-fold for having severe (vs. mild) GERD among NTG cases compared with DTG cases (OR = 8.5; 95% CI: 5.0, 14.7).Table: Nighttime GERD (NTG) and Daytime GERD (DTG) by Severity.Conclusions: Patients with nocturnal heartburn or acid regurgitation may report more severe symptoms. Clinicians should inquire specifically about nighttime symptoms in addition to daytime symptoms when evaluating patients with GERD.