and six months after treatment
GERD‐specificPsychometrically validated
|
Does not include atypical symptomsDoes not assess short‐term treatment responseNot self‐assessedReproducibility > six months has not been assessedNot available in different languages
|
|
Ulcer Esophagitis Subjective Symptom Scale (UESS) [84]
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Visual analog scale to evaluate four dimensions (abdominal pain, reflux discomfort, intestinal discomfort, and sleep difficulties)Administered at baseline and four weeks after treatment
|
Self‐assessedMultidimensionalPsychometrically validated
|
Not GERD‐specificDoes not monitor symptoms dailyNot available in different languages
|
|
GERD Symptom Assessment Scale (GSAS) [85]
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15‐item patient assessment tool evaluating various dimensions of 15 GI‐related symptoms
|
GERD‐specificMultidimensionalSelf‐assessedPsychometrically validatedSensitive to changes in severity of symptoms over time
|
Not available in different languagesDoes not monitor symptoms daily
|
|
Gastroesophageal Reflux Disease Activity (GRACI) [86]
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Five‐item diary of GERD symptoms every day for one weekCombined with data obtained during a clinic visitAdministered at baseline and at three‐month intervals
|
GERD‐specificMultidimensionalPsychometrically validatedProven validity and reliability
|
Not available in different languages
|
|
GERD Symptoms Frequency Questionnaire (GSFQ) [87]
|
Six questions that assess the frequency of GERD symptoms in the previous seven days, and the effects of GERD on sleep, daily activities, and eating
|
GERD‐specificSelf‐assessedPsychometrically validated
|
Not multidimensionalNot available in different languagesRarely used in clinical trials
|
|
GERD assessment scales [88]
|
Consists of three separate scales: GERD burden scale, symptom scale (seven common symptoms related to GERD), and treatment scale (evaluating patient behaviors to control symptoms)
|
GERD‐specificMultidimensionalSelf‐assessedPsychometrically validated
|
The scales have not been separately validated, so the entire tool must be usedNo daily assessment of symptomsNot available in different languages
|
|
Gastrointestinal Symptom Rating Scale (GSRS) [89, 90]
|
Combines 15 items into 5 symptom clusters (reflux, abdominal pain, indigestion, diarrhea, constipation)Evaluates GI symptoms over time or after treatment
|
Self‐assessedAvailable in different languagesHas been shown to correlate with the Short Form‐36 and Psychological General Well Being scale [89]
|
Not GERD‐specificOriginally developed for PUD and IBSDifferent language versions have shown differences in psychometric properties
|
|
Patient‐assessed Upper Gastrointestinal Symptom Severity Index (PAGI‐SYM) [91]
|
Self‐assessment tool for patients with GERD, dyspepsia, and gastroparesisEvaluates 20 items with 6 subscales (heartburn/regurgitation, nausea/vomiting, upper abdominal pain, lower abdominal pain, bloating, and fullness/early satiety
|
Self‐assessedMultidimensionalAvailable in different languagesPsychometrically validated
|
Not GERD‐specificNo assessment of daily symptomsOnly assesses symptom severity and not frequency
|
|
Reflux Disease Questionnaire (RDQ) [92]
|
12 questions to assess severity/frequency of pain and burning behind the breastbone, acid taste in the mouth, and upper stomach pain/burning
|
GERD‐specificSelf‐assessedPsychometrically validated
|
No assessment of daily symptomsPrimarily used in German‐speaking patients
|
|
GERD Questionnaire (GERDQ) [93]
|
Evaluates the frequency/severity of heartburn, regurgitation, and feeling of gastric acidity, along with antacid use
|
GERD‐specificSelf‐assessedMultidimensionalPsychometrically validated
|
Only usable in Chinese‐speaking patientsNo assessment of daily symptoms
|
|
Frequency Scale for Symptoms of GERD (FSSG) [94]
|
12‐question instrument that evaluates frequency of typical GERD symptoms
|
GERD‐specificSelf‐assessed
|
Only usable in Japanese‐speaking patientsNo assessment of daily symptoms
|
|
PPI Acid Suppression Symptom Test (PASS‐test) [95]
|
Five‐item questionnaire to evaluate patients on PPI therapy who have persistent symptoms, and to monitor their response
|
GERD‐specificSelf‐assessedPsychometrically validated
|
Only available in English and FrenchNo measurement of severity or frequency of symptoms
|
|
Symptom diary [96]
|
Three‐item questionnaire that focuses only on heartburn (one completed in the morning and the last two in the evening)Evaluates burning feeling at night, severity of most intense burning during the day, and number of antacids taken over previous 24 hours
|
GERD/Heartburn‐specificSelf‐assessed
|
Not available in different languageNo assessment of daily symptomsNot multidimensionalNot psychometrically validated
|
|
Reflux Questionnaire (ReQuest) [97–99]
|
Tracks GERD symptoms and patient well‐being over timeLong and short version that evaluate seven dimensions (acid complaints, upper abdominal complaints, lower abdominal complaints, nausea, disorders of sleep, general well‐being, and other symptoms)
|
GERD‐specificMultidimensionalAssesses daily symptomsPsychometrically validatedAvailable in multiple languages
|
Mostly used in clinical researchScore analysis is complex
|
|
|
Has two subscales that evaluate GI symptoms and well‐being
|
|
|
Conclusion
Esophageal disease is a significant source of patient symptoms worldwide, and symptoms result from a complex neurophysiologic response to the activation of a variety of nociceptors. Patient clinical features can also vary, as some present with more typical symptoms such as heartburn or regurgitation, whereas other patients may present with symptoms that overlap with adjacent organs. In each patient, obtaining a thorough clinical history and physical exam is therefore critical, and further evaluation requires the appropriate use of radiographic, endoscopic, and manometric studies to aid in patient diagnosis and management.
Over the last several decades, esophageal symptoms have accounted for significant healthcare utilization in the form of clinic visits, endoscopic procedures, medication usage, and surgical intervention. This has placed a considerable financial burden on health systems worldwide. Providers need to be cognizant not only of this but also of the significantly negative impact that esophageal disease has on patient QoL and workplace productivity.
References
1 1 Modlin IM, Moss SF, Kidd M, Lye KD. Gastroesophageal reflux disease: then and now. J Clin Gastroenterol 2004; 38(5):390–402.
2 2 Enterline HT, Pathology of the esophagus. Springer‐Verlag; 1984.
3 3 Paterson
