GERD scoring system developed for diagnosis in resource-poor settings
MedWire News: A simple scoring system that assesses both symptom frequency and severity may be effective for diagnosing gastroesophageal reflux disease (GERD) in resource-poor settings, suggest study findings.
In western countries patients with GERD symptoms are diagnosed by endoscopy or 24-h pH monitoring.
However, Lakmali Amarasiri (University of Kelaniya, Ragama, Sri Lanka) and colleagues say that these techniques are “often invasive, costly, and not freely available,” especially in resource-poor countries.
They therefore evaluated the efficacy of a symptom-based scoring system for diagnosing GERD in 100 patients with GERD-like symptoms and 150 healthy volunteers with no symptoms or history of upper gastrointestinal disease. All the patients with symptoms of GERD underwent upper gastrointestinal endoscopy; 77 were found to have evidence of reflux esophagitis and 23 had normal results.
The researchers compared two possible scoring systems, the first of which assessed symptom frequency alone. Each of the seven symptoms studied (heartburn, regurgitation, abdominal/chest pain, abdominal distension, dysphagia, cough, belching) was given a score of 1 to 5 depending on whether the symptom was absent (1), occurred once a month (2); once a week (3); two to four times a week (4), or daily (5). The total maximum score was 35 and the minimum score was 7.
The second system assessed both symptom frequency and severity. For severity, symptoms were scored 1 for no discomfort at all, 2 for mild discomfort that does not interfere with day-to-day activities, 3 for moderate discomfort that interferes with day-to-day activities at least once a week, and 4 for severe discomfort that interferes with day-to-day activities and sleep more than once a week. The symptom score was then multiplied by the severity score to give a total out of 20 for each symptom, and a maximum overall score of 140 and a minimum score of 7.
Presence or absence of GERD was confirmed by 24-h ambulatory esophageal pH monitoring in the cases. Controls did not undergo invasive testing as it was considered unethical.
The team calculated respective cut-off scores and area under the receiver operating curve (AUC) scores of 10.5 and above and 0.93 for scoring system 1, and 12.5 and above and 0.93 for scoring system 2. Mean scores for systems 1 and 2 in patients with GERD symptoms and controls were 18.0 versus 9.0 and 38.5 versus 10.9, respectively.
Fifty one cases and 74 controls were randomly selected to test score efficacy. Of these, 49 individuals were diagnosed as having GERD using the cut off values. System 1 correctly diagnosed 44 cases and system 2 correctly diagnosed 46 cases, validated using 24-hour pH-metry. Sensitivity and specificity for diagnosing GERD were 89.7% and 92.4%, respectively, for system 1 and a corresponding 93.8% and 94.0% for system 2.
System 2 scoring also showed better correlation with the results of the pH monitoring than system 1 scoring.
“A score using both symptom frequency and severity correlates better with an objective measure, such as 24-h ambulatory pH monitoring,” conclude the authors in the European Journal of Gastroenterology and Hepatology.
They add: “We recommend that it can be used as a case-finding tool in epidemiological studies, once its validity in the community setting is established.”
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By Helen Albert