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Can subjective symptoms predict objective findings in gastroesophageal reflux disease patients?

  • 2021 SAGES Oral
  • Published:
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Abstract

Introduction

Medical therapy is the first-line treatment for gastroesophageal reflux disease, but surgical options are available and shown to be effective when medical management fails. There is no consensus for when a surgical evaluation is indicated. We set out to determine if the GERD-HRQL questionnaire scores correlate to objective findings found in patients undergoing anti-reflux surgery to predict when surgical consultation could be warranted.

Methods

A prospectively gathered database was used for patients undergoing anti-reflux surgery from January 2014 to September 2020. Inclusion criteria required a diagnosis of GERD and comprehensive esophageal workup with the GERD-HRQL questionnaire, EGD, esophageal manometry, and ambulatory pH monitoring. Analysis of the GERD-HRQL scores was compared to objective endpoints to see correlation and predictability. Logistic regression analysis was used to assess relationship between the presence of objective findings and GERD-HRQL questionnaire scores.

Results

There were 246 patients meeting inclusion criteria. There was no significant correlation between GERD-HRQL score and DeMeester score (correlation coefficient = 0.23), or presence of a hiatal hernia, regardless of size (p = 0.89). Patients with esophagitis had significantly higher average GERD-HRQL scores compared to those without esophagitis (40.1 ± 18.9 vs 30.4 ± 19.1, p < 0.0001). Patients with a score of 40 or greater had a 42% to 65% probability of having esophagitis versus a score of 30 or less, lowering the chances of having esophagitis to less than 35%.

Conclusion

Usage of a GERD-HRQL questionnaire score can potentially show the correlation between subjective and objective findings in the workup of a patient for anti-reflux surgery. Specifically, patients with a GERD-HRQL score of 40 or greater have an increased probability of esophagitis compared to those with a score of 30 or less. Using these scores can help referring clinicians identify those patients failing medical therapy and allow for prompt referral for surgical evaluation.

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References

  1. Nebel OT, Fornes MF, Castell DO (1976) Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis 21(11):953–956

    Article  CAS  Google Scholar 

  2. Richter JE, Rubenstein JH (2018) Presentation and epidemiology of gastroesophageal reflux disease. Gastroenterology 154(2):267–276

    Article  Google Scholar 

  3. Tustumi F, Bernardo WM, da Rocha JR, Szachnowicz S, da Costa Seguro FC, Bianchi ET, Takeda FR, de Miranda Neto AA, Sallum RA, Cecconello I (2020) Anti-reflux surgery for controlling respiratory symptoms of gastro-esophageal reflux disease: a systematic review and meta-analysis. Asian J Surg 44(1):2–10

    Article  Google Scholar 

  4. Orlando RC (2000) Gastroesophageal reflux disease [Internet]. New York: CRC Press; 3: epidemiology of gastroesophageal reflux disease http://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=nlebk&AN=44826&site=ehost-live. Accessed 18 Dec 2020

  5. Dean BB, Crawley JA, Schmitt CM, Wong J, Ofman JJ (2003) The burden of illness of gastro-oesophageal reflux disease: impact on work productivity. Aliment Pharmacol Ther 17(10):1309–1317

    Article  CAS  Google Scholar 

  6. Everhart JE, Ruhl CE (2009) Burden of digestive diseases in the United States part I: overall and upper gastrointestinal diseases. Gastroenterology 136(2):376–386

    Article  Google Scholar 

  7. Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 20(2):130–134

    Article  CAS  Google Scholar 

  8. Rossetti G, Limongelli P, Cimmino M, Napoletano D, Bondanese MC, Romano G, Pratilas M, Guerriero L, Orlando F, Conzo G, Amato B (2014) Outcome of medical and surgical therapy of GERD: predictive role of quality of life scores and instrumental evaluation. Int J Surg 1(12):S112–S116

    Article  Google Scholar 

  9. Vela MF (2014) Diagnostic work-up of GERD. Gastrointest Endosc Clin 24(4):655–666

    Article  Google Scholar 

  10. Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD (2010) SAGES guidelines committee guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 24(11):2647–2669

    Article  Google Scholar 

  11. Spechler SJ (1992) Department of veterans affairs gastroesophageal reflux disease study group* comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. N Engl J Med 326(12):786–792

    Article  CAS  Google Scholar 

  12. Belafsky PC, Postma GN, Koufman JA (2002) Validity and reliability of the refux symptom index RSI. J Voice 16(2):274–277

    Article  Google Scholar 

  13. Armstrong D (1999) Endoscopic evaluation of gastro-esophageal reflux disease. Yale J Biol Med 72(2–3):93–100

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Stein HJ, DeMeester TR, Hinder RA (1992) Outpatient physiologic testing and surgical management of foregut motility disorders. Curr Prohl Surg 29:413–555

    CAS  Google Scholar 

  15. Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA (1996) Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 183(3):217–224

    CAS  PubMed  Google Scholar 

  16. Kulig M, Leodolter A, Vieth M, Schulte E, Jaspersen D, Labenz J, Lind T, Meyer-Sabellek W, Malfertheiner P, Stolte M, Willich SN (2003) Quality of life in relation to symptoms in patients with gastro-oesophageal reflux disease—an analysis based on the ProGERD initiative. Aliment Pharmacol Ther 18(8):767–776

    Article  CAS  Google Scholar 

  17. Wiklund I, Talley NJ (2003) Update on health-related quality of life in patients with gastroesophageal reflux disease. Expert Rev Pharmacoecon Outcomes Res 3(3):341–350

    Article  Google Scholar 

  18. Kamolz T, Pointner R, Velanovich V (2003) The impact of gastroesophageal reflux disease on quality of life. Surg Endosc Other Interv Tech 17(8):1193–1199

    Article  CAS  Google Scholar 

  19. Velanovich V, Karmy-Jones R, Hawasli A, Scheeres DE (1998) Measuring gastroesophageal reflux disease: relationship between the health-related quality of life score and physiologic parameters/Discussion. Am Surg 64(7):649

    CAS  PubMed  Google Scholar 

  20. Triadafilopoulos G (2004) Changes in GERD symptom scores correlate with improvement in esophageal acid exposure after the Stretta procedure. Surg Endosc Other Interv Tech 18(7):1038–1044

    CAS  Google Scholar 

  21. Johnson DA, Fennerty MB (2004) Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease. Gastroenterology 126(3):660–664

    Article  Google Scholar 

  22. Locke GR, Talley NJ, Weaver AL, Zinsmeister AR (1994) A new questionnaire for gastroesophageal reflux disease. InMayo Clin Proc 69(6):539–547

    Article  CAS  Google Scholar 

  23. Stanghellini V, Armstrong D, Mönnikes H, Bardhan KD (2007) Systematic review: do we need a new gastro-oesophageal reflux disease questionnaire? Digestion 75(Suppl. 1):3–16

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA

    Madeline Rasmussen, Marc A. Ward & Christine Sanchez

  2. Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA

    Madeline Rasmussen, Steven G. Leeds & Marc A. Ward

  3. Texas A & M College of Medicine, Bryan, TX, USA

    Marc A. Ward, Kevin Chin & Luke Hansen

  4. Research Institute,, Baylor Scott and White Health, Dallas, TX, USA

    Christine Sanchez & Gerald O. Ogola

  5. Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA

    Steven G. Leeds

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  1. Madeline Rasmussen
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  2. Steven G. Leeds
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  7. Gerald O. Ogola
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Correspondence to Steven G. Leeds.

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Disclosures

Steven Leeds is a consultant for Ethicon and Boston Scientific. Marc Ward is a consultant for Boston Scientific. Madeline Rasmussen, Christine Sanchez, Kevin Chin, Luke Hansen, and Gerald Ogola have no conflicts of interest or financial ties to disclose.

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Rasmussen, M., Leeds, S.G., Ward, M.A. et al. Can subjective symptoms predict objective findings in gastroesophageal reflux disease patients?. Surg Endosc 36, 6293–6299 (2022). https://doi.org/10.1007/s00464-022-09037-9

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  • DOI: https://doi.org/10.1007/s00464-022-09037-9

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