Validation of a Gastro-oesophageal Reflux Disease (GERD) Specific Screening Instrument for Epidemiological Purposes
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Date
2007
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University of Kelaniya
Abstract
Introduction: The prevalence of GERD is increasing worldwide: the community
prevalence in Sri Lanka is not known.
Objectives : To develop a practical clinical score to screen for GERD in the community
and assess whether a score using both symptom frequency and severity correlates better
to an objective measure of GERD than one using only symptom frequency.
Methodology : 100 patients (endoscopy positive - which included patients with all
grades of oesophagitis) and 150 controls (comparable in age and gender) faced a GERDspecific
interviewer-administered questionnaire assessing seven upper gastro-intestinal
symptoms. Each symptom was graded using Likert scales for frequency (4-items) and
severity (5-items) and two scores were generated. Score 1 being the sum of frequency of
symptoms while score 2 was the sum of products of frequency and severity of each. All
patients then underwent 24-h ambulatory pHmetry. Both symptom scores were compared
against 24-h pHmetry parameters as it is considered the gold standard to diagnose GERD.
Cut-off values were determined by receiver-operating characteristic curves.
Results : For both scores, mean scores of cases were significantly higher than controls
(p=O.OOO). The cut-off score for score 1 was 2': 10.50 (sensitivity 92.0 %; specificity 78.7
%; area under the curve- 0.937). The cut-off score for score 2 was 2': 12.50 (sensitivity
90.0%; specificity 78.0%; area under the curve - 0.929). Both showed high
reproducibility (Intra class correlation coefficient score1: 0.94 and score2: 0.82). There
was good correlation between both symptom scores and 24-h pHmetry parameters
(Spearman rank correlation, p=0.01), but score 2 showed a significantly better
correlation.
Conclusion: Our GERD questionnaire is valid, reproducible and showed better
correlation with an objective test when both severity and frequency of symptoms were
scored than frequency alone.
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Amarasiri, W.A.D.L., Pathmeswaran, A., Ranasinha, C. and de Silva, H.J., 2007. Validation of a Gastro-oesophageal Reflux Disease (GERD) Specific Screening Instrument for Epidemiological Purposes, Proceedings of the Annual Research Symposium 2007, Faculty of Graduate Studies, University of Kelaniya, pp 145.