Sensitivity and specificity of the Gastrointestinal Short Form Questionnaire in diagnosis of gastroesophageal reflux disease

Prevalence and Risk Factors of Gastroesophageal Reflux Disease in Bulgaria: An Internet-Based Survey

BACKGROUND

The global pooled prevalence of gastroesophageal reflux disease (GORD) is approximately 14% and varies significantly according to the country. More population-based studies are needed in regions lacking epidemiological data on the prevalence of GORD, such as Eastern Europe, particularly Bulgaria. This current study aimed to evaluate the prevalence of GORD in Bulgaria and assess the risk factors associated with this disorder.

METHODS

An internet-based health survey was sent to Bulgarian adults. Individuals were invited to complete an online questionnaire on general and gastrointestinal health. The aim of the study was not explicitly stated. The survey collected data on sociodemographic and behavioral characteristics, validated questions to assess GORD, diagnostic questions based on Rome IV criteria to assess irritable bowel syndrome (IBS) and functional dyspepsia (FD), and questions about antisecretory drugs usage.

RESULTS

Data were collected from 1,896 individuals (mean age = 35.5 years, SD = 11.7, 73.1% females). The prevalence of GORD in the study population was 27.5%, while 57.29% of all GORD patients taking PPIs had PPI-refractory GORD. Age (p = 0.02), body mass index (BMI) (p < 0.001), marital status (p = 0.03), occupation (p < 0.001), sexual problems (p < 0.001), FD (p < 0.001), and IBS (p < 0.001) were significantly associated with GORD prevalence. Patients with FD (p < 0.001; OR 5.38), IBS (p = 0.03; OR 1.07), and with higher BMI (p < 0.001, OR 1.05) were at an increased risk of having GORD.

CONCLUSIONS

The first data on GORD prevalence in the adult population in Bulgaria have been reported. Disorders of gut-brain interaction have a significant impact on the prevalence of GORD.

The study and comparative analysis of GerdQ and GSRS Questionnaires on gastroesophageal reflux disease diagnostics

Introduction

Clinical questionnaires have some limitations compared to instrumental diagnosis of gastroesophageal reflux disease (GERD), but clinical diagnosis of GERD based on typical symptoms is pragmatic and well-established by societal guidelines.

Aim

To study the diagnostic value and provide comparative analysis of GerdQ and GSRS questionnaires regarding the GERD diagnostics based on a comparison of the questionnaires with the results of intraluminal oesophageal impedance-pH monitoring in Ukraine.

Material and methods

Twenty-eight patients (11 men and 17 women with a mean age of 47 ±2.4 years and a mean body mass index of 25.6 ±1.1 kg) filled in the GerdQ and GSRS questionnaires and underwent 24-hour multichannel intraluminal oesophageal impedance-pH monitoring.

Results

The GerdQ questionnaire showed a significantly strong correlation between the total score of the questionnaire and the key indicators of 24-hour impedance-pH monitoring: AET (r_s = 0.793), acid reflux episodes (r_s = 0.796), and liquid reflux episodes (r_s = 0.730). Correlation of reflux syndrome according to the GSRS questionnaire was established between the acid reflux episodes (r_s = 0.530), the episodes of all fluid refluxes (r_s = 0.598), and AET (r_s = 0.560), but the strength of the correlation relationships is weaker. The GerdQ questionnaire showed a sensitivity of 78.6%, specificity of 92.9%, and accuracy (diagnostic efficiency) of 85.7%.

Conclusions

The use of the GerdQ questionnaire for the diagnosis of GERD is optimal in everyday practice for deciding whether to prescribe “ex juvantibus” therapy or whether to use instrumental examination methods (upper endoscopy, oesophageal pH monitoring, oesophageal impedance-pH monitoring).

Mapping of the Gastrointestinal Short Form Questionnaire (GSF-Q) into EQ-5D-3L and SF-6D in patients with gastroesophageal reflux disease

BACKGROUND

The short, self-administered Gastroesophageal Reflux Disease (GERD) Symptom Frequency Questionnaire (GSFQ) is a specific Quality of Life (QoL) instrument which measures the impact of GERD symptoms on QoL. This study aims to map the specific scores in GSFQ into two generic instruments: SF-6D and EQ-5D-3 L, in order to obtain utility estimates derived from the GERD condition.

METHOD

A national representative sample of GERD patients was selected, stratified by gender, age (< 45, ≥45 years) and GERD severity (0-I, II-IV Savary-Miller score) for validation purposes. Age, gender, BMI, GERD diagnose, GERD severity, associated comorbidities and risk factors were recorded. GSFQ, SF-6D, EQ-5D-3 L, and the HRQoL Visual Analogue Scale (VAS) were answered by patients. Several mapping methods were estimated, regression using dummy variables, and linear, quadratic and cubic regression using optimal factor scores. The use of a GERD aggregated summary severity derived from the GSFQ was dimed the best predictor. Overall Mean Absolute Error (MAE), overall Mean Absolute Percentage Error (MAPE) were used as goodness-of-fit (GOF) indexes to compare models.

RESULTS

A total of 3405 patients were recruited by 490 clinicians. Mean age was 49 (±14.4) years and 49.8% were women. Reported comorbidities were clustered in 6 antecedents and 15 concomitant pathologies. Aggregation of levels for the frequency of symptoms items was found more suitable for estimation. Regression weights were found to follow a monotonous progressive pattern. Overall MAE ranged from 0.092 to 0.094 for SF-6D utility prediction and from 0.008 to 0.08 for EQ-5D-3 L, while MAPE values ranged from 27.9 to 29% for SF-6D and from 36.8 to 38.4% for EQ-5D-3 L. Cubic regression GOF demonstrated a better fit.

CONCLUSIONS

It is possible to translate specific GSFQ scores assessing GERD condition into generic SF-6D and EQ-5D-3 L utility values. Although regression using dummy variables is a suitable mapping procedure, other alternative mapping methods convey better fit, in particular cubic regression.

Questionnaires for the diagnosis of gastroesophageal reflux disease: are they really useful?

Gastroesophageal reflux disease (GERD) is a major medical complaint both in primary care and gastroenterology clinics. This is partly due to the condition's high prevalence, which in developed countries is estimated to be 10-20%. Its initial diagnosis, however, remains controversial. The Montreal definition of GERD is widely accepted, and both heartburn and regurgitation are therein considered the syndrome's typical symptoms. However, in the DIAMOND study only 49% of patients with GERD surprisingly reports these symptoms as major causes of disability (40%) heartburn, 9% regurgitation).