The complete remission concept

The presence of esophageal lesions and gastroesophageal reflux disease (GERD) symptoms do not coincide in some patients: some individuals suffer from the symptoms of GERD but have no evidence of GERD at endoscopy; while conversely, some with endoscopic evidence of GERD do not experience symptoms. In order to combine both healing of esophageal lesions and the presence of symptoms when measuring treatment efficacy, the concept of complete remission has been redefined to include both parameters. Until recently, an effective means of measuring GERD symptoms and response to therapy had been lacking. The symptomatic reflux questionnaire ReQuest(TM) was therefore developed; it is a validated, self-administered, hierarchical, dimension-oriented scale to assess response of a broad range of symptoms to treatment. It measures the frequency and intensity of seven symptom dimensions: acid complaints; upper abdominal complaints; lower abdominal complaints; nausea; sleep disturbances; other complaints; and general well-being (intensity only). ReQuest(TM) has recently been combined with an adaptation of the Los Angeles classification for endoscopic measurement of GERD, thus linking the assessment of symptom relief and healing of esophageal lesions. The new ReQuest(TM)/ LA-classification enables the detailed clinical characterization of GERD patients at any stage and accurate assessment of treatment outcome by a single global measure.