TOPLINE:

In patients undergoing ambulatory reflux monitoring off therapy for suspected gastroesophageal reflux disease (GERD), dominant symptom intensity (DSI) — a score combining symptom severity and frequency — correlated with validated questionnaires, was associated with objective reflux burden, and tracked improvement in symptoms after therapy.

METHODOLOGY:

• Patient-reported outcome instruments help qualify and quantify reflux-related symptoms, guide the initial clinical approach to GERD, and assess treatment benefit from the patient’s perspective; however, tools that pinpoint each patient’s single most burdensome symptom remain understudied.
• Researchers retrospectively analyzed pooled data from 808 adults (mean age, 53.8 years; 65.2% female) referred for ambulatory 24-hour pH-impedance testing off acid suppression for suspected GERD to evaluate the value of DSI as an adjunctive patient-reported outcome.
• Participants completed comprehensive esophageal questionnaires before testing, including a DSI score derived from paired 5-point Likert ratings of frequency (0-4) and severity (0-4) over a 2-week recall period for typical and atypical symptoms; ratings for each symptom’s frequency and severity were multiplied, and the symptom score with the highest numerical value was used as the DSI.
• DSI was compared with validated instruments, including global symptom severity (GSS), the GERD questionnaire (GerdQ), and the reflux symptom index (RSI).
• Change in DSI after reflux management was assessed in a subset of 148 patients, with data collected during follow-up assessments of esophageal symptoms.

TAKEAWAY:

• The mean baseline DSI was 9.37; patients with dominant typical symptoms had a higher symptom burden, as measured by DSI, than those with dominant atypical symptoms (P < .0001).
• DSI demonstrated significant positive correlations with GSS (Spearman correlation coefficient [R], 0.682; P < .0001), GerdQ (R, 0.414; P < .0001), and RSI (R, 0.577; P < .0001). It also showed significant correlations with objective reflux metrics, including significant positive correlations with acid exposure time (R, 0.175; P < .0001) and total reflux episodes (R, 0.194; P < .0001) and a significant negative correlation with mean nocturnal baseline impedance (R, -0.157; P < .0001).
• On receiver operating characteristic (ROC) curve analysis, DSI (area under the ROC curve [AUROC], 0.600) was noninferior to GSS (AUROC, 0.618), GerdQ (AUROC, 0.580), and RSI (AUROC, 0.520) in predicting conclusive GERD; DSI was also noninferior to these instruments in predicting pathologic acid exposure time and total reflux episodes.
• In patients with follow-up assessments, mean DSI decreased by about 6 points, and this improvement strongly correlated with percentage GSS change (R, 0.632; P < .0001) and patient satisfaction with therapy (R, 0.531; P < .0001); percent DSI change independently predicted both outcomes and performed comparably to GSS in identifying highly satisfied patients.

IN PRACTICE:

“The DSI can be utilized by clinicians to highlight the most burdensome symptoms during initial assessment, and its change over time correlates with satisfaction with therapy. It is a useful addition to esophageal symptom questionnaires for both clinical and research-related applications,” the authors of the study wrote.

SOURCE:

The study was led by Matthew Schroeder, MD, Washington University School of Medicine, St. Louis. It was published online in the Journal of Clinical Gastroenterology.

LIMITATIONS:

As ordinal data, the difference between ranked Likert scale responses may not be linear or proportional. Selecting the symptom with the highest product of frequency and duration may not fully capture the additive effects of multiple bothersome symptoms. The study included two large tertiary centers in North America, and reflux-related symptoms vary globally, so results may not be fully generalizable.

DISCLOSURES:

One author was supported by an award from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.