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Construct Overview of GERD/Dyspepsia

Please note that this section is an archive and is no longer being updated.

Background

Dyspepsia is defined as upper abdominal discomfort or pain, which may be accompanied by bloating, nausea, and related symptoms. Although recurrent dyspepsia may occur in the absence of identifiable pathology (functional dyspepsia), dyspepsia may also be associated with digestive diseases such as peptic ulcer and gastroesophageal reflux disease (GERD).¹ GERD is a disorder in which the contents of the stomach reflux into the esophagus due to incomplete closure of the lower esophageal sphincter. In addition to causing acute discomfort, GERD is a risk factor for cancers of the esophagus, larynx, and pharynx and may complicate some respiratory diseases.^2,3

Digestive diseases are highly prevalent in the United States and are associated with direct costs exceeding $85 billion annually. GERD is one of the most prevalent digestive diseases, affecting approximately 19 million Americans, and is also associated with the highest costs and rates of health care utilization of all digestive diseases.⁴

VA Relevance

Digestive diseases and symptoms are common among VA health care users. In a study of patients in VA acute and primary care outpatient clinics, rates of dyspepsia were ≥ 30% and rates of frequent heartburn were ≥= 21%.⁵ Between 1970 and 1995, rates of hospitalization for GERD and esophageal cancer substantially increased within the VA health system.⁶

Dyspepsia and gastroesophageal reflux symptoms are associated with increased VA health care utilization and lower self-reported health status. Costs associated with treatment of digestive diseases are substantial, with outpatient pharmacy costs alone accounting for over $80 million spent annually.⁵ The high prevalence and impact of digestive diseases among the VA user population underscore a need for valid and reliable assessment tools for use in epidemiological surveys and clinical trials.

Measurement

Medical tests and procedures, such as endoscopy, may be used to identify organic causes or exacerbations of some conditions associated with dyspepsia (e.g., peptic ulcers, esophageal inflammation). However, a substantial number of persons have "functional" dyspepsia that is not associated with observable signs of pathology.^7,8 Consequently, assessment of self-reported symptoms is essential to assessing health status and clinical change.

Because different digestive diseases often have overlapping symptom profiles, diagnostic or disease-specific tools should be designed to discriminate among different conditions. This is complicated somewhat by the fact that symptoms are not uniform across persons with the same disorder and vary in frequency and intensity.⁹ For example, although heartburn is a symptom that is highly specific to GERD, alone it is not a particularly sensitive for GERD (i.e., it is relatively common to have GERD but not always experience heartburn). Thus, disease-specific measures for GERD and dyspepsia should assess multiple symptom dimensions and the characteristics (e.g., frequency) of each.⁹

The effects of dyspepsia and GERD on quality of life^8,10 have prompted the development of questionnaires that assess the broader effects of symptoms on general well being. Generic instruments have been used to examine health-related quality of life associated with a number of digestive diseases. Over the past decade, many instruments have been developed specifically to assess health-related quality of life in populations with digestive diseases. These instruments may be classified as system-specific (i.e., relevant across different digestive diseases) or disease-specific (i.e., especially designed for persons with a particular disease or syndrome such as GERD). For reviews of published instruments relevant to GERD and dyspepsia, see Fraser et al.⁷ and Stanghellini et al.⁹

Through literature review, METRIC identified 6 commonly used instruments used in the assessment of digestive diseases including GERD and dyspepsia. Three of these instruments are system-specific (i.e., used to assess a range of digestive diseases), and 3 are specific to GERD. These instruments are ranked according to number of citations, as determined by the ISI Web of Knowledge.¹¹ What follows is a brief summary of each instrument and three applicable references.

Most Frequently Cited Instruments

All Digestive Diseases

1. Bowel Disease Questionnaire (BDQ)
   [230 Citations]
2. Gastrointestinal Quality of Life Index (GIQLI)
   [178 Citations]
3. Gastrointestinal Symptom Rating Scale (GSRS)
   [171 Citations]

GERD-Specific

1. Carlsson-Dent GERD Questionnaire
   [126 Citations]
2. Gastroesophageal Reflux Questionnaire (GERQ)
   [103 Citations]
3. Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL)
   [87 Citations]

1. National Digestive Diseases Information Clearinghouse. Indigestion [fact sheet]. Accessed February 2006. Available: http://digestive.niddk.nih.gov/ddiseases/pubs/indigestion/index.htm.
2. National Digestive Diseases Information Clearinghouse. Heartburn, hiatal hernia, and gastroesophageal reflux disease (GERD) [fact sheet]. Accessed February 2006. Available: http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/gerd.pdf.
3. El-Serag HB, Hepworth EJ, Lee P, Sonnenberg A. Gastroesophageal reflux disease is a risk factor for laryngeal and pharyngeal cancer. Am J Gastroenterol 2001;96:2013-2018. [Abstract]
4. Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C, Gemmen E, Shah S, Avdic A, Rubin R. The burden of selected digestive diseases in the United States. Gastroenterol 2002;122:1500-1511. [Abstract]
5. Dominitz JA, Provenzale D. Prevalence of dyspepsia, heartburn, and peptic ulcer disease in veterans. Am J Gastroenterol 1999;94:2086-8093. [Abstract]
6. El-Serag HB, Sonnenberg A. Opposing time trends of peptic ulcer and reflux disease. Gut 1998;43:327-333. [Abstract]
7. Fraser A, Delaney B, Moayyedi P. Symptom-based outcomes measures for dyspepsia and GERD trials: a systematic review. Am J Gastroenterol 2005;100:442-452. [Abstract]
8. Talley NJ, Weaver AL, Zinsmeister AR. Impact of functional dyspepsia on quality of life. Dig Dis Sci 1995;40:485-589. [Abstract]
9. Stanghellini V, Armstrong D, Mönnikes H, Bardhan KD. Systematic review: do we need a new gastro-oesophageal reflux disease questionnaire? Aliment Pharmacol Ther 2004;19:463-479. [Abstract]
10. Revicki DA, Wood M, Maton PN, Sorensen S. The impact of gastroesophageal reflux disease on health-related quality of life. Am J Med 1998;104:252-258. [Abstract]
11. ISI Web of Knowledge. Accessed January 2006. Available: http://isi01.isiknowledge.com/portal.cgi/wos/.