Symptom evaluation in gastroesophageal reflux disease

Area of Science:

• Gastroenterology
• Clinical Therapeutics
• Patient-Reported Outcomes

Background:

• Traditional GERD therapy evaluation relies heavily on endoscopic healing of esophageal lesions.
• Most GERD patients have non-erosive reflux disease (NERD) with no visible lesions, challenging endoscopic assessment.
• GERD symptoms are diverse, including extraesophageal manifestations impacting quality of life.

Purpose of the Study:

• To advocate for a shift in GERD therapy evaluation from endoscopic criteria to symptom-based assessments.
• To highlight the limitations of endoscopic endpoints in evaluating treatment efficacy, especially in NERD.
• To emphasize the importance of patient-reported outcomes in judging therapeutic success.

Main Methods:

• Review of current paradigms for evaluating GERD therapy success.
• Discussion of the limitations of endoscopic evaluation for both erosive GERD and NERD.
• Introduction of multisymptom, patient-administered questionnaires as objective tools.

Main Results:

• Endoscopic evaluation is insufficient for assessing GERD therapy, particularly in NERD patients.
• GERD-related symptoms, including extraesophageal ones, significantly affect patient quality of life.
• Validated, quantitative, and responsive symptom questionnaires are crucial for objective evaluation.

Conclusions:

• GERD therapy success should be primarily determined by symptom diminishment, reflecting patient experience.
• Multisymptom GERD questionnaires, like ReQuest, offer a reliable method for objective assessment.
• Symptom-based tools improve monitoring of patient response to therapy, leading to better GERD management.