Background/Aims: The growing importance of symptom assessment is evident from the numerous clinical studies on gastroesophageal reflux disease (GERD) assessing treatment-induced symptom relief. However, to date, the a priori selection of criteria defining symptom relief has been arbitrary. The present study was designed to prospectively identify GERD symptom thresholds for the broad spectrum of GERD-related symptoms assessed by the validated reflux questionnaire (ReQuest™) and its subscales, ReQuest™-GI (gastrointestinal symptoms) and ReQuest™-WSO (general well-being, sleep disturbances, other complaints), in individuals without evidence of GERD. Methods: In this 4-day evaluation in Germany, 385 individuals without evidence of GERD were included. On the first day, participants completed the ReQuest™, the Gastrointestinal Symptom Rating Scale, and the Psychological General Well-Being scale. On the other days, participants filled in the ReQuest™ only. GERD symptom thresholds were calculated for ReQuest™ and its subscales, based on the respective 90th percentiles. Results: GERD symptom thresholds were 3.37 for ReQuest™, 0.95 for ReQuest™-GI, and 2.46 for ReQuest™-WSO. Conclusion: Even individuals without evidence of GERD may experience some mild symptoms that are commonly ascribed to GERD. GERD symptom thresholds derived in this study can be used to define the global symptom relief in patients with GERD.

Journal Section:
Original Paper
Keywords:
Gastroesophageal reflux disease, Symptom thresholds, GERD, Symptom evaluation, GERD-related, ReQuest™, Reflux questionnaire, Gastrointestinal Symptom Rating Scale, Psychological General Well-Being scale
1.
Guedon C: How to diagnose gastroesophageal reflux? Part 1. Diagnostic value of symptoms. Interpretation and role of endoscopy (in French). Gastroenterol Clin Biol 1999;23:S202–S207.
2.
Wiklund IK, Glise H: Quality of life in different gastrointestinal conditions. Eur J Surg 1998;582(suppl):56–61.
3.
Dent J, Brun J, Fendrick AM, Fennerty MB, Janssens J, Kahrilas PJ, Lauritsen K, Reynolds JC, Shaw M, Talley NJ, on the behalf of the Genval Workshop Group: An evidence-based appraisal of reflux disease management – The Genval Workshop Report. Gut 1999;44(suppl 2):S1–S16.
https://doi.org/10.1136%2Fgut.44.2008.S1
4.
Moss SF, Armstrong D, Arnold R, Ferenci P, Fock KM, Holtmann G, McCarthy DM, Moraes-Filho JP, Mutschler E, Playford R, Spechler SJ, Stanghellini V, Modlin IM: GERD 2003 – A consensus on the way ahead. Digestion 2003;67:111–117.
[PubMed]
https://doi.org/10.1159%2F000071290
5.
Stanghellini V, Armstrong D, Mönnikes H, Bardhan KD: Systematic review: Do we need a new gastro-oesophageal reflux disease questionnaire? Aliment Pharmacol Ther 2004;19:463–479.
[PubMed]
https://doi.org/10.1046%2Fj.1365-2036.2004.01861.x
6.
Armstrong D, Mönnikes H, Bardhan KD, Stanghellini V: The construction of a new evaluative GERD questionnaire – Methods and state of the art. Digestion 2004;70:71–78.
[PubMed]
https://doi.org/10.1159%2F000080465
7.
Bardhan KD, Stanghellini V, Armstrong D, Berghöfer P, Gatz G, Mönnikes H: Evaluation of GERD symptoms during therapy. Part I. Development of the new GERD questionnaire ReQuest™. Digestion 2004;69:229–237.
[PubMed]
https://doi.org/10.1159%2F000079707
8.
Mönnikes H, Bardhan KD, Stanghellini V, Berghöfer P, Bethke TD, Armstrong D: Evaluation of GERD symptoms during therapy. Part II. Psychometric evaluation and validation of the new questionnaire ReQuest™ in erosive GERD. Digestion 2004;69:238–244.
[PubMed]
https://doi.org/10.1159%2F000079708
9.
Bardhan KD, Stanghellini V, Armstrong D, Berghöfer P, Gatz G, Mönnikes H: International validation of ReQuest™ in patients with endoscopy negative gastroesophageal reflux disease. Aliment Pharmacol Ther 2004;20:891–898.
[PubMed]
https://doi.org/10.1111%2Fj.1365-2036.2004.02194.x
10.
Castell DO, Kahrilas PJ, Richter JE, Vakil NB, Johnson DA, Zuckermann S, Skammer W, Levine JG: Esomeprazole (40 mg) compared with lansoprazole (30 mg) in the treatment of erosive esophagitis. Am J Gastroenterol 2002;97:575–583.
[PubMed]
https://doi.org/10.1016%2FS0002-9270%2801%2904094-1
11.
Talley NJ, Lauritsen K, Tunturi-Hihnala H, Lind T, Moum B, Bang C, Schulz T, Omland TM, Delle M, Junghard O: Esomeprazole 20 mg maintains symptom control in endoscopy-negative gastro-oesophageal reflux disease: A controlled trial of ‘on-demand’ therapy for 6 months. Aliment Pharmacol Ther 2001;15:347–354.
[PubMed]
https://doi.org/10.1046%2Fj.1365-2036.2001.00943.x
12.
Dettmer A, Vogt R, Sielaff F, Luhmann R, Schneider A, Fischer R: Pantoprazole 20 mg is effective for relief of symptoms and healing of lesions in mild reflux oesophagitis. Aliment Pharmacol Ther 1998;12:865–872.
[PubMed]
https://doi.org/10.1046%2Fj.1365-2036.1998.00381.x
13.
Hatlebakk JG, Hyggen A, Madsen PH, Walle PO, Schulz T, Mowinckel P, Bernklev T, Berstad A, on behalf of the Norwegian Heartburn Study Group: Heartburn treatment in primary care: Randomised, double blind study for 8 weeks. BMJ 1999;319:550–553.
[PubMed]
14.
Mathus-Vliegen EM, Tytgat GN: Gastro-esophageal reflux in obese subjects: Influence of overweight, weight loss and chronic gastric balloon distension. Scand J Gastroenterol 2002;37:1246–1252.
[PubMed]
https://doi.org/10.1080%2F003655202761020498
15.
Ter RB, Johnston BT, Castell DO: Influence of age and gender on gastroesophageal reflux in symptomatic patients. Dis Esophagus 1998;11:106–108.
[PubMed]
16.
Sharma N, Donnellan C, Preston C, Delaney B, Duckett G, Moayyedi P: A systematic review of symptomatic outcomes used in oesophagitis drug therapy trials. Gut 2004;53(suppl 4):58–65.
17.
Enck P, Dubois D, Marquis P: Quality of life in patients with upper gastrointestinal symptoms: Results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol 1999;231(suppl):48–54.
https://doi.org/10.1080%2F003655299750025264
18.
Dimenas E, Carlsson G, Glise H, Israelsson B, Wiklund I: Relevance of norm values as part of the documentation of quality of life instruments for use in upper gastrointestinal disease. Scand J Gastroenterol Suppl 1996;221:8–13.
[PubMed]
https://doi.org/10.3109%2F00365529609095544
19.
Huang JQ, Hunt RH: pH, healing rate and symptom relief in patients with GERD. Yale J Biol Med 1999;72:181–194.
[PubMed]
© 2005 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2005
You do not currently have access to this content.