Abstract
BackgroundScales for aiding physicians diagnose gastro-oesophageal reflux disease (GERD) have not been evaluated in terms of their ability to discriminate between troublesome symptoms (TS) and non-troublesome symptoms (NTS). Our objective is to evaluate the ability of the Reflux Disease Questionnaire (RDQ) to identify GERD according to referral of TS, in patients without previous proton pump inhibitor (PPI) treatment and in patients on PPI treatment.MethodsPatients consulting physicians because of heartburn or acid regurgitation were recruited at 926 primary-care centres in Spain. They were asked to complete several questionnaires including the RDQ, and to define which of their symptoms were troublesome. Information on drug treatment was collected by the physician. We performed a receiver operating characteristic (ROC) curve analysis to ascertain the RDQ's optimum cut-point for identifying TS.Results4574 patients were included, 1887 without PPI and 2596 on PPI treatment. Among those without PPI treatment, 1722 reported TS. The area under the curve (AUC) was 0.79 for the RDQ, and the optimum RDQ cut-point for identifying TS was 3.18 (sensitivity, 63.2%; specificity, 80.2%). A total of 2367 patients on PPI treatment reported TS, and the optimum RDQ cut-off value was 3.06 (sensitivity, 65.4%; specificity, 71.8%).ConclusionsAn RDQ score higher than 3 shows good sensitivity and specificity for differentiating TS from NTS among patients without PPI or on PPI treatment. The RDQ is useful in primary care for diagnosis of GERD based on the Montreal definition.
Highlights
Scales for aiding physicians diagnose gastro-oesophageal reflux disease (GERD) have not been evaluated in terms of their ability to discriminate between troublesome symptoms (TS) and non-troublesome symptoms (NTS)
In Western societies, 30% [1] to 60% [2] of persons suffer from heartburn or regurgitation, yet not all those who report these symptoms suffer from gastro-oesophageal reflux disease (GERD)
GERD is usually diagnosed without invasive testing, and the neither of the following aspects is known: the extent to which the Reflux Disease Questionnaire (RDQ) is useful for differentiating troublesome from nontroublesome reflux symptoms, a key factor for diagnosing GERD within the new conceptual framework proposed by the Montreal Consensus; and, the RDQ's capacity to distinguish symptom severity
Summary
Scales for aiding physicians diagnose gastro-oesophageal reflux disease (GERD) have not been evaluated in terms of their ability to discriminate between troublesome symptoms (TS) and non-troublesome symptoms (NTS). Any given person's perception of a symptom as troublesome goes beyond its frequency, its severity or even its impact on quality of life [6], since it implies individual cognitive assessment which may vary according to the circumstances [7] When it comes to the severity of GERD -an aspect of crucial importance to the physician because it is precisely on this that his attitude to diagnosis and therapy will so often depend [8,9]- the Montreal Consensus does not specify how GERD severity is to be assessed in clinical practice, assuming the degree of severity to be that reported by the patient [10]. GERD is usually diagnosed without invasive testing, and the neither of the following aspects is known: the extent to which the RDQ is useful for differentiating troublesome from nontroublesome reflux symptoms, a key factor for diagnosing GERD within the new conceptual framework proposed by the Montreal Consensus; and, the RDQ's capacity to distinguish symptom severity
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