The Value Of Gastroesophageal Reflux Disease Questionnaire In The Diagnosis Of Gastroesophageal Reflux Disease And Survey On The Risk Factors Of Gastroesophageal Reflux Disease

BackgroundGastroesophageal reflux disease(GERD) is a common chronic digestive disease,and its morbidity is increasing in China. GerdQ was a new diagnostic and evaluative tool for GERD.And its validity and reliability has proven in foreign,but in the domestic need further clinical study.Heartburn and regurgitation were the main clinical manifestations of the gastroesophageal reflux disease (GERD),but GERD had a relatively broad and complex symptom spectrum.The etiology of GERD included both genetic and environmental factors.But in current, there were many controversies about environmental factors which impacted GERD. Because of GERD associated with sleep disorders,anxiety and depression,many patients had a serious decline in quality of life. The relationship among GERD, sleep disorder, anxiety and depression also need to be further studied.Objective1. To evaluate the value of gastroesophageal reflux disease questionnaire(GerdQ) in the diagnosis of gastroesophageal reflux disease.2. To investigate symptom spectrum and risk factors including sleep disorders, anxiety and depression of gastroesophageal reflux disease. MethodsDuring March 2009 to June 2010 ,outpatients of the First Affiliated Hospital of Anhui Medical University which with typical heartburn and regurgitation or those were diagnosed reflux esophagitis (RE) or Barrett esophagus through endoscopic examination were investigated. And the questionnaire included gastroesophageal reflux disease questionnaire (GerdQ), the reflux disease diagnostic questionnaire (RDQ), GERD patients questionnaire,the Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HAD). The total of subjects had 370 cases and controls had 347 cases.Results①Taking 7 as GerdQ threshold score for GERD, the maximal Youden index was 0.79,and the area under the receiver operating characteristic curve (ROC) was 0.89, the true positive diagnostic rate was 88.71%,and true negative diagnostic rate was 90.48% with sensitivity of 91.35% and specificity of 87.61%. The GerdQ score unrelated positively with severity of reflux esophagitis.②Taking 12 as RDQ threshold score for GERD,the diagnostic sensitivity and specificity were 77.30% and 85.83%, and Youden index reached the maximum value of 0.63 for diagnosis of GERD patients. The positive coincidence rate was 86.38%, negative coincidence rate was 77.94%. ROC area under the curve (Az) was 0.78.And GerdQ had more diagnostic sensitivity than RDQ.③GERD symptom spectrum were broad and varied,and the typical clinical manifestations were heartburn and regurgitation, accounting for 84.05% and 70.00%. And the incidence of major associated symptoms of RE and NERD patients there was no significant difference (P> 0.05).④Among GERD patients, the male to female ratio was 1.14:1, and the age of 40 to 59-year-old was the commonest. Low education level, smoking, eating greasy, constipation,overweight or obesity and esophageal hiatal hernia may be the most important risk factors.⑤There were 92 patients with nocturnal heartburn and regurgitation in subjects, accounting for 24.86%, associated with sleep disturbance in 82 cases, accounting for 22.16%, with anxiety were 52 cases, accounting for 14.05%, with depression were 48 cases, accounting for 12.97%, anxiety and depression were present in 40 cases, accounting for 10.81%. Compared with PSQI, HAD points and the constitution of sleep disorders, anxiety and depression in subjects and controls, the difference was significant (P <0.01). Compared with PSQI, HAD points in heartburn and regurgitation severity, there was significant difference (P <0.05). Compared with PSQI, HAD points and the constitution of sleep disorders, anxiety and depression in nocturnal symptom group and no nocturnal symptom group, the difference was significant (P <0.01).And nocturnal symptom and sleep disturbance, anxiety, depression, existsed positive correlation. Compared with PSQI, HAD points and the constitution of sleep disorders, anxiety and depression in frequency of nocturnal symptom the difference was significant ( P <0.01). Compared with PSQI, HAD points and the constitution of sleep disorders, anxiety and depression in RE group and NERD group, the difference was significant (P <0.01).ConclusionsGerdQ seems to be an useful screening tool in initial diagnosis of GERD.Both GerdQ and RDQ were good tools in the diagnosis of GERD, and they had the same diagnostic specificity,but the diagnostic sensitivity of GerdQ was higher than RDQ.Heartburn and regurgitation were the main symptom of GERD.And RE and NERD patients had similar clinical presentation.And the pathogenesis of GERD had a variety of factors. Sleep disorders, anxiety and depression were closely related with GERD. Sleep disorders, anxiety and depression and GERD influenced one another.