Prevalence of gastro-oesophageal reflux disease with upper gastrointestinal symptoms without heartburn and regurgitation

• Published in: United European gastroenterology journal 2014-06, Vol.2 (3), p.173-178
• Main Authors: Vakil, Nimish, Wernersson, Börje, Ohlsson, Lis, Dent, John
• Format: Article
• Language: English
• Subjects: Bloating; gastro-oesophageal reflux disease; heartburn; oesophageal endoscopy; oesophageal pH monitoring; Original; regurgitation; upper abdominal pain
• ISSN: 2050-6406; 2050-6414
• DOI: 10.1177/2050640614532458

Background:Symptomatically ‘silent’ gastro-oesophageal reflux disease (GORD) may be underdiagnosed. Objective:To determine the prevalence of untreated GORD without heartburn and/or regurgitation in primary care. Methods:Patients were included if they had frequent upper gastrointestinal symptoms and had not taken a proton pump inhibitor in the previous 2 months (Diamond study: NCT00291746). GORD was diagnosed based on the presence of reflux oesophagitis, pathological oesophageal acid exposure, and/or a positive symptom–acid association probability. Patients completed the Reflux Disease Questionnaire (RDQ) and were interviewed by physicians using a prespecified symptom checklist. Results:GORD was diagnosed in 197 of 336 patients investigated. Heartburn and/or regurgitation were reported in 84.3% of patients with GORD during the physician interviews and in 93.4% of patients with GORD when using the RDQ. Of patients with heartburn and/or regurgitation not identified at physician interview, 58.1% (18/31) reported them at a ‘troublesome’ frequency and severity on the RDQ. Nine patients with GORD did not report heartburn or regurgitation either at interview or on the RDQ. Conclusions:Structured patient-completed questionnaires may help to identify patients with GORD not identified during physician interview. In a small proportion of consulting patients, heartburn and regurgitation may not be present in those with GORD.