Multicenter comparative study on the value of gastroesophageal reflux disease questionnaire and proton pump inhibitors test in diagnosis of gastroesophageal reflux disease

Abstract

Objective To investigate the diagnostic value of gastroesophageal reflux disease questionnaire (GerdQ), esophagogastroduodenoscopy (EGD) and proton pump inhibitor (PPI) test in gastroesophageal reflux disease (GERD) in Chinese population. Methods This was a national wide multicenter study. From April 2012 to December 2012, outpatients in the departments of gastroenterology of nine hospitals, aged over 18 years old and with upper gastrointestinal problems were selected as study objectives. GerdQ were completely filled out with guide by all patients. The patients with GerdQ≥8 received gastroscopy, 24-hour impedance-pH monitoring and PPI test. Chi square test was used for statistical analysis. Results The number of patients with GerdQ≥8 was 5 349. Among the 1 584 patients who received EGD, 465(29.4%) cases had reflux esophagitis (RE), 75(4.7%) cases had peptic ulcers, and nine (0.6%) cases had upper gastrointestinal malignant tumors. Among the 328 patients received 24-hour impedance-pH monitoring, 130 patients presented with positive results, and 48 (36.9%) patients were diagnosed with RE by EGD. Among the 198 patients with negative results in 24-hour impedance-pH monitoring, 35(17.7%) patients were diagnosed with RE by EGD. The diagnostic rate of RE in patients with positive results was higher than that in patients with negative results, and the difference was statistically significant (χ2=15.379, P<0.01). The positive rates of PPI test of patients received no 24-hour impedance-pH monitoring and received 24-hour impedance-pH monitoring were 85.4%(549/643) and 89.6%(120/134), respectively, and the difference was not statistically significant (χ2=1.612, P=0.204). The positive rate of 24-hour impedance-pH monitoring in patients with positive PPI test was 61.2%(120/196), which was higher than that of patients with negative PPI test (41.2%, 14/34), and the difference was statistically significant (χ2=4.789, P=0.038). Conclusions GerdQ has important reference value in the diagnosis of GERD. However, in consideration of the high incidence of upper gastrointestinal cancer in China, patients with upper gastrointestinal symptoms should receive EGD before treatment. Afterwards PPI treatment could be directly utilized. Key words: Gastroesophageal reflux; Questionnaires; Gastroscopes; Proton pump inhibitors