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Protocol - Gastroesophageal Reflux Disease (GERD) Symptoms

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Description:

The Gastroesophageal Reflux Disease Questionnaire (GerdQ) is a 6-item questionnaire that helps identify patients with gastroesophageal reflux disease (GERD). Patients are asked to report frequency of symptoms over the past 7 days.

Protocol:

For the next 6 questions please think about your symptoms over the past 7 days . . .

1. How often did you have a burning feeling behind your breastbone (heartburn)?

0 [ ] 0 days

1 [ ] 1 day

2 [ ] 2–3 days

3 [ ] 4–7 days

2. How often did you have stomach contents (liquid or food) moving upwards to your throat or mouth (regurgitation)?

0 [ ] 0 days

1 [ ] 1 day

2 [ ] 2–3 days

3 [ ] 4–7 days

3. How often did you have pain in the center of the upper stomach?

3 [ ] 0 days

2 [ ] 1 day

1 [ ] 2–3 days

0 [ ] 4–7 days

4. How often did you have nausea?

3 [ ] 0 days

2 [ ] 1 day

1 [ ] 2–3 days

0 [ ] 4–7 days

5. How often did you have difficulty getting a good night's sleep because of your heartburn and/or regurgitation?

0 [ ] 0 days

1 [ ] 1 day

2 [ ] 2–3 days

3 [ ] 4–7 days

6. How often did you take additional medications for your heartburn and/or regurgitation other than what your physician told you to take (such as Tums, Rolaids, Maalox)?

0 [ ] 0 days

1 [ ] 1 day

2 [ ] 2–3 days

3 [ ] 4–7 days

Scoring Information

Scores ranging from 0 to 3 were applied for the positive predictors and from 3 to 0 (reversed order, where 3 = none) for negative predictors. The Gastroesophageal Reflux Disease Questionnaire (GerdQ) score was calculated as the sum of these scores, giving a total score ranging from 0 to 18. Those with a score of 8 or more have a high likelihood of having Gastroesophageal Reflux Disease (GERD), and those with less than 8 have low or no likelihood. For more detailed scoring information, see the reference in the Source section.

Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.

Availability:

Publicly available

Personnel and Training Required
None
Equipment Needs
None
Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire

Life Stage:

Adult

Participants:

Adults, aged 18 years and older

Specific Instructions:

If the administration of the GerdQ produces a positive score for GERD, the Gastrointestinal Working Group (WG) recommends performing a pH impedence test to confirm the results and determine disease severity. Please see the Gastrointestinal WG Supplemental Information for a pH impedence test protocol.

The Gastroesophageal Reflux Disease Questionnaire (GerdQ) is a proprietary instrument that is available for use with permission from AstraZeneca.

To use the Gastroesophageal Reflux Disease Questionnaire (GerdQ), permission must be obtained from AstraZeneca. To obtain permission, contact AstraZeneca at PROinformation@astrazeneca.com and complete a License Agreement.

Selection Rationale

The Gastroesophageal Reflux Disease Questionnaire (GerdQ) was selected because it is readily available, easy to use, and fairly accurate at diagnosing gastroesophageal reflux disease (GERD).

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Person Gastroesophageal Reflux Disease Symptom Assessment 3163052 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) GERD symptoms proto 62973-3 LOINC
Derived Variables

None

Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

Jones, R., Junghard, O., Dent, J., Vakil, N., Halling, K., Wernersson, B., & Lind, T. (2009). Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Alimentary Pharmacology and Therapeutics, 30(10), 1030–1038.

General References

Chehade, R. J., Lacy, B. E., & Crowell, M. D. (2010, May). Gastroesophageal reflux disease: A prospective study comparing a symptom-based reflux disease questionnaire to BRAVO pH capsule monitoring. Poster presented at the Digestive Disease Week conference, New Orleans, LA.

Vakil, N., van Zanten, S. V., Kahrilas, P., Dent, J., & Jones, R. (2007). The Montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. American Journal of Gastroenterology, 101(8), 1900–1920.

Protocol ID:

191101

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX191101_Addtional_Medications_Frequency PX191101060000 For the next 6 questions please think about your symptoms over the past 7 days... How often did you take additional medications for your heartburn and/or regurgitation other than what your physician told you to take (such as Tums, Rolaids, Maalox)? 4 N/A
PX191101_Difficulty_Sleeping_Frequency PX191101050000 For the next 6 questions please think about your symptoms over the past 7 days... How often did you have difficulty getting a good night's sleep because of your heartburn and/or regurgitation? 4 N/A
PX191101_Heartburn_Frequency PX191101010000 For the next 6 questions please think about your symptoms over the past 7 days... How often did you have a burning feeling behind your breastbone (heartburn)? 4 N/A
PX191101_Nausea_Frequency PX191101040000 For the next 6 questions please think about your symptoms over the past 7 days... How often did you have nausea? 4 N/A
PX191101_Regurgitation_Frequency PX191101020000 For the next 6 questions please think about your symptoms over the past 7 days... How often did you have stomach contents (liquid or food) moving upwards to your throat or mouth (regurgitation)? 4 N/A
PX191101_Stomach_Pain_Frequency PX191101030000 For the next 6 questions please think about your symptoms over the past 7 days... How often did you have pain in the center of the upper stomach? 4 N/A
Research Domain Information
Measure Name:

Gastroesophageal Reflux Disease (GERD) Symptoms

Release Date:

December 13, 2010

Definition

This questionnaire asks about symptoms of heartburn, pain, and regurgitation in the past 7 days to determine the presence of gastroesophageal reflux disease (GERD).

Purpose

This measure is used to assist health care professionals in the diagnosis and effective management of patients with gastroesophageal reflux disease (GERD).

Keywords

Esophagus, gastroesophageal reflux disease, GERD, pH monitoring, heartburn, reflux, regurgitation, Gastrointestinal, proprietary