Symptom Priority Ranking in the Care of Gastroesophageal Reflux: A Review of 1,850 Cases

Abstract

Background: Clinical history remains an important part of the medical evaluation of patients with gastroesophageal reflux disease (GERD). Heartburn, regurgitation, and dysphagia are considered typical symptoms of GERD. Priority rankings of these symptoms can be determined with a standardized questionnaire. Objective: To determine whether symptom priority ranking and symptom severity grading can provide useful information in the evaluation of patients with GERD. Methods: From 1,850 patients that were analyzed retrospectively, patients with dysphagia unrelated to GERD were excluded. A standardized questionnaire was applied before each patient underwent any esophageal diagnostic study. Priority of symptoms was determined to be primary, secondary, tertiary, or none based on the patient response to the questionnaire. Presence of a stricture was determined either by endoscopy, esophagraphy, or both studies. Stationary esophageal manometry and 24-hour pH monitoring were performed on all patients. Through bivariate and multivariate analysis, the relationships among typical GERD symptoms, esophageal reflux-related stenosis, lower esophageal sphincter pressure, and composite score were established. Results: High priority ranking of the symptom dysphagia is predictive of the presence of an esophageal stricture, but has a negative association with abnormal manometric and pH studies. In contrast, high priority ranking of the symptom heartburn and regurgitation are positively associated with abnormal manometric and pH results. Conclusions: Priority ranking can be a valuable adjunct to objective testing in the evaluation of GERD. In certain clinical situations it can obviate the need for 24-hour pH monitoring.

Esophageal Intraepithelial Eosinophils in Dysphagic Patients with Gastroesophageal Reflux Disease

“…However we have successfully used it in our practice over the last 20 years. The clinical use of this ranking method has been studied in a large series of patients with reflux symptoms [17]. Another potential limitation is selection bias related to the referral pattern of the subjects.…”

Dysphagia in Adult Japanese Is Not Equivalent to the Grade of Endoscopic Reflux Esophagitis

“…It is well documented that precise and structured questionnaires regarding reflux symptoms are useful for diagnosis of GERD, and that heartburn and acid regurgitation are specific symptoms and are associated with abnormal manometric and pH results (11)(12)(13)(14)(15)(16). It is also shown that a brief and simple questionnaire is reliable for noting changes in reflux symptoms (17,18 T a b l e 3 .…”

Gastro�sophageale Refluxkrankheit

“…Treten sie nüchtern oder nachts auf, liegt oftmals ein höherer Grad der Ösophagitis vor [56,62]. Das Vorhandensein von Sodbrennen und Säurere-gurgitation ist positiv assoziiert mit pathologischen Werten in der pH-Metrie und Manometrie [39]. Johnson und Fennerty fanden für Sodbrennen einen positiven prädik-tiven Wert von 59% und für die Kombination von Sodbrennen und Regurgitation von 66% [26].…”

“…Es gibt zunehmend Untersuchungen über die Validität von Symptomerhebungsbögen [39,46]. Die am meisten verwendeten Fragebögen sind mit dem Ziel entwickelt worden, Therapieergebnisse zu erfassen [36,50].…”