Reliability of symptom assessment in dyspepsia

Best practice in symptom assessment: a review

“…5 Agreement on the presence versus the absence of symptoms is usually better than agreement about symptom intensity. 11 Empirical evidence of mismatches between clinician and patient ratings of symptoms in GORD Previous research into mismatch between patient and clinician ratings of symptoms was borne out in secondary analyses of data on file at AstraZeneca, which were carried out specifically for this workshop. The data related to a large sample of both male and female patients, aged 18-80 years, whose dominant symptom was heartburn.…”

“…Lack of interrater reliability between clinicians has been demonstrated. 11 Holmes and colleagues 12 have suggested that clinicians may focus primarily on frequency and intensity of symptoms in their history taking while patients also consider symptom related disability and the impact on quality of life in judging the severity of their symptoms.…”

“…18 The use of a structured record or questionnaire 16 may facilitate elicitation of symptoms by a clinician but even this will not guarantee consistency in characterising or assessing symptoms. 11 …”

Dyspepsia: management guidelines for the millennium

“…Patients with dysmotility-like dyspepsia are almost as likely to have underlying peptic ulcer disease as those classified as having ulcer-like dyspepsia, 19 and symptom clusters do not help in defining whether uninvestigated dyspepsia is caused by structural or functional disease. [20][21][22] It should be noted however that more recently the subgrouping of patients with functional dyspepsia according to their predominant or most bothersome symptom has been shown to be useful in predicting the response to PPI therapy, 23 and the implications of this for management are addressed in more detail below. One conclusion that can be drawn is that documentation of the patient's most bothersome symptom may prove to be of benefit in guiding treatment.…”

The validity of a symptom diary in ratings of dyspepsia measured against a detailed interview: do patients and clinicians agree in their assessment of symptoms?

“…Heading et al. demonstrated similar difficulties in dyspepsia severity rating and found poor interobserver agreement concerning the grading of symptom severity but a good common understanding, when they rated presence or absence of symptoms 16 …”