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01-11-2009 | Gastroenterology | Article

GerdQ helps diagnose and manage GERD in primary care

Abstract

Free abstract

MedWire News: Researchers have developed a useful tool to help family practitioners diagnose and manage gastro-esophageal reflux disease (GERD) without the need for initial specialist referral or endoscopy.

“Primary care physicians face challenges both in making an accurate diagnosis of GERD and in its management,” note Roger Jones, from King’s College London in the UK, and colleagues.

To develop a self-assessment questionnaire, which could help primary care physicians better diagnose and manage the condition, the researchers analyzed data on over 300 primary care patients participating in the DIAMOND study.

The patients were aged 18–79 years and presented with upper abdominal symptoms believed to be originating in the gastrointestinal tract. The patients were screened and completed three GERD outcome questionnaires: the Reflux Disease Questionnaire, the Gastrointestinal Symptom Rating Scale, and the Gastro-oesophageal Reflux Disease Impact Scale.

From the data gathered, the team identified which items on the three questionnaires gave the most accurate diagnosis of GERD. They then held qualitative interviews with patients to determine the optimum number of items to use and the best wording to ensure clarity.

The final GerdQ questionnaire consisted of six items – four positive predictors for GERD and two negative predictors.

The four positive predictors comprise: heartburn, regurgitation, sleep disturbance because of these two reflux symptoms, and the use of over-the-counter medication used in addition to that prescribed. The two negative predictors are epigastric pain and nausea.

The frequency of the items over the previous week were then scored 0 for 0 day, 1 for 1 day, 2 for 2–3 days, and 3 for 4–7 days, giving a total score of 0–18.

As reported in the journal Alimentary Pharmacology and Therapeutics, Jones et al found that GerdQ diagnosed GERD with a similar accuracy to that of gastroenterologists participating in the DIAMOND study. At a cut-off of 8 points, GerdQ accurately detected 65% of patients with GERD and 71% of patients without GERD. This was slightly better than the 60% accuracy reported for family physicians.

GerdQ is also able to identify patients in whom GERD has a greater impact on their lives. Patients with a total score of at least 3 out of a possible 6 on the two negative predictors are those most likely to be impacted by their disease and who may therefore need more aggressive treatment, say the researchers.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

By Lucy Piper