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Protocol - Gastroesophageal Reflux Disease (GERD) Symptoms

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Protocol Name from Source:

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

Availability:

Publicly available

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.

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Adult

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.

Research Domain Information

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).

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 Assessment3163052CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)GERD symptoms proto62973-3LOINC

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_Heartburn_FrequencyPX191101010000For 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)?4N/A
PX191101_Regurgitation_FrequencyPX191101020000For 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)?4N/A
PX191101_Stomach_Pain_FrequencyPX191101030000For 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?4N/A
PX191101_Nausea_FrequencyPX191101040000For the next 6 questions please think about your symptoms over the past 7 days... How often did you have nausea?4N/A
PX191101_Difficulty_Sleeping_FrequencyPX191101050000For 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?4N/A
PX191101_Addtional_Medications_FrequencyPX191101060000For 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)?4N/A