Stomach Flu

Summary text

This study found that the GERD Impact Scale (GIS) has good psychometric properties, with most physicians reporting that it facilitated clinical decision making. By helping patient–physician communication, the GIS will therefore be a useful aid for managing patients with GERD in the primary care setting.

Key findings

The GIS is a simple communication tool with good psychometric properties in both newly diagnosed and chronic GERD patients.Most physicians (77%) considered the GIS to be a useful aid to clinical decision making.GIS results altered physicians’ treatment decisions in 35% of patients overall.Extended abstract

Background: Primary care physicians generally base treatment decisions for patients with gastroesophageal reflux disease (GERD) on the patient’s report of his/her symptoms. However, ineffective communication often results in poor patient–physician agreement about the presence of symptoms and their severity. Consequently, there is considerable scope for a structured questionnaire that may aid patient–physician communication about GERD symptoms, as a means of improving management of GERD.

Aim: To develop and validate a short questionnaire to aid patient self-reporting about the presence and impact of GERD symptoms.

Methods: The GERD Impact Scale (GIS), which comprises 8 questions about the frequency and impact of GERD symptoms over the past week and the use of additional non-prescription medication, was developed based on a systematic literature review, focus groups of patients (n = 21) and physicians (n = 25), and patient cognitive interviews. Psychometric validation was conducted using a two-visit, multicenter study in GERD patients with newly diagnosed (n = 100) or chronic (n = 105) disease who were willing to start prescription drug therapy for their symptoms. At each visit (separated by a mean interval of 16 days), patients completed the GIS and other questionnaires (Quality of Life in Reflux and Dyspepsia [QOLRAD] and Reflux Disease Questionnaire [RDQ]).

Results: Internal consistency and reproducibility of the GIS was demonstrated; Cronbach alpha coefficients ranged from 0.68 to 0.82 and intraclass correlation coefficients in patients with stable symptoms ranged from 0.61 to 0.72. Concurrent validity of the GIS with the QOLRAD and RDQ was demonstrated by statistically significant (p<0.001) Spearman rank correlations (0.5–0.8 in both patient groups). The GIS was shown to be responsive to change based on effect sizes, which ranged from 0.62–0.87 in the overall population (0.9–1.5 in newly diagnosed and 0.32–0.42 in chronic GERD patients). Most (77%) physicians found it useful to evaluate the GIS results from visit 1 alongside visit 2 results. Treatment decisions were subsequently altered as a result of the GIS in 35% of patients overall (46% of newly diagnosed and 25% of chronic GERD patients).

Conclusions: The GIS is a simple communication tool that was shown to have internal consistency, reproducibility, construct validity and responsiveness to change in both newly diagnosed and chronic GERD patients. Most physicians considered it to be a useful tool to aid clinical decision making in the management of GERD patients in the primary care setting.

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