[Diagnostic usefulness of the Carlsson-Dent questionnaire in gastroesophageal reflux disease (GERD)]. / Utilidad diagnóstica del cuestionario de Carlsson-Dent en la enfermedad por reflujo gastroesofágico (ERGE).

BACKGROUND: Diagnosis of GERD is based on presence of symptoms (heartburn) associated to abnormal esophageal acid exposure or esophageal erosions determined by 24-hr pH monitoring and/or endoscopy, respectively. Different instruments have been evaluated in order to diagnose GERD without invasive studies. Carlsson-Dent questionnaire (CDQ), validated among European patients, have shown good sensitivity and positive predictive values for detection of GERD. Diagnostic usefulness of the CDQ in Mexican patients is unknown. OBJECTIVE: To evaluate usefulness of CDQ among patients with erosive GERD (EG) and non-erosive GERD (NERD). PATIENTS AND METHODS: Consecutive patients with heartburn at least twice per week during the last three months and previous endoscopy were included. All patients answered a self-administered Spanish version of the CDQ, previously evaluated for its content validity and easy application. A score of > or = 4 was considered as positive for GERD. All patients underwent 24-hr pH esophageal monitoring to determine the presence of pathologic reflux (% time pH < 4, > 4.2), as well as the symptom index (SI). Questionnaire's sensitivity (S), specificity (E), positive and negative predictive values (PPV, NPV) were calculated using 24-hr pH monitoring and endoscopic oesophagitis as gold-standard tests. RESULTS: A total of 125 patients were evaluated, 81 women (65%) and 44 men (35%) with an age of 47.9 (21-83). Eighty-six patients (69%) had NERD and 39 (31%) EG. Among patients with NERD, 28 (32%) had abnormal pH study, 10 (12%) had normal pH study with positive SI (> 50%), and 48 (65%) had normal pH study with negative SI. Most common symptom was a burning feeling rising from the stomach or lower chest up towards the neck (classic definition of heartburn) in 53%, noncardiac chest pain in 14%, and nausea in 5%. In 44 patients (35%) the main discomfort occurred within 2 hours of taking food, and in 77% it worsed with larger meals and food rich in fat, as well as in 77% after taking spicy food. One hundred and seven patients (86%) scored > or = 4 on CDQ and there was no significantly difference between CDQ score among groups. CDQ's sensitivity compared to pH monitoring was 89%, and PPV 55%. When compared to endoscopic findings, sensitivity was 94% and PPV 90. There was strong and significative correlation between esophageal acid exposure and higher CDQ's scores. CONCLUSIONS: CDQ in Spanish is an useful instrument for detection of GERD, and its score correlates with the degree of esophageal acid exposure.

[Perception of symptoms with minimal reductions of esophageal pH in patients with erosive and non-erosive GERD]. / Percepción de síntomas con descensos mínimos en el pH esofágico en pacientes con ERGE erosiva y no erosiva.

BACKGROUND: Patients with gastrointestinal reflux disease GERD perceive < 5% of acid reflux episodes, independently of GERD type. The role of minimal changes on esophageal pH (1 or 2 units) on development of symptoms is unknown. OBJECTIVE: To evaluate symptom perception and its relationship with minimal changes on esophageal pH in patients with erosive and non-erosive GERD (NERD). PATIENTS AND METHODS: We evaluated consecutive patients with symptomatic GERD. All patients had endoscopy in the previous 8 weeks. All patients underwent 24-h esophageal pH-monitoring. Abnormal pH-metry was defined as % time of pH < 4 > 4.2. Symptom index (SI) was considered positive when > or = 50. We also calculated SI at pH 5 and pH 6. Patients with GERD were classified into three groups: 1) abnormal pH and negative SI. For statistical analysis, we used the test-Student, chi 2, and ANOVA test. P < 0.05 was considered statistically significant. RESULTS: We evaluated 120 patients, 79 (66%) females and 41 (34%) males with mean age of 47.8 years (range 21-83 years). Eighty three (69%) patients had NERD and 37 (31%), erosive esophagitis (EE). Seventy two patients (87%) with NERD and 36 (97%) with erosive GERD developed symptoms during the study. NERD patients had mean of 69 reflux episodes compared with 184 of patients with EE. Perception of reflux symptoms was significantly higher in the group with EE (3.4 vs. 1.02 p < 0.0001). Among patients with NERD, 33% had abnormal pH-metry and 67%, a normal test. Of these patients, nine (16%) had normal pH test and positive SI, and 47 (83%) normal pH test and negative SI. There was no difference in symptom perception among the three groups. Patients with NERD and abnormal pH had similar SI patients with EE; 4% of patients with normal pH and negative SI at pH 4 had positive SI when calculated at pH 5, and 68% when SI was calculated at pH 6. CONCLUSIONS: The majority of acid reflux episodes are not perceived and this phenomenon is independent of erosive or non-erosive GERD. Patients with erosive esophagitis had significantly higher esophageal acid exposure than patients with NERD. Minimal changes in esophageal pH (1 or 2 pH units) increases SI in patients with GERD, especially in those with normal esophageal acid exposure.