Pediatr Gastroenterol Hepatol Nutr.  2019 Jul;22(4):341-349. 10.5223/pghn.2019.22.4.341.

The Gastroesophageal Reflux Disease Questionnaire in Adolescents: What Is the Best Cutoff Score?

• Artanti D
• Hegar B
• Kaswandani N
• Soedjatmiko
• Prayitno A
• Devaera Y
• Vandenplas Y

• KMID: 2451574
• DOI: http://doi.org/10.5223/pghn.2019.22.4.341

Abstract

BACKGROUND
A self-assessment questionnaire, the GERD-Questionnaire (GERD-Q) was used to determine the prevalence of GERD in adolescents, describe the related factors, and determine the impact on quality of life (QoL).
METHODS
The incidence of GERD was evaluated using the GERD-Q in adolescents aged 12-18 years. The Pediatric Gastroesophageal Reflux Disease Symptom Questionnaire and Quality of Life Questionnaire (PGSQ-A) for adolescents were additionally administered. Some factors considered related to GERD were also evaluated.
RESULTS
The 520 adolescents were included. The prevalence of suspected GERD, according to a GERD-Q cutoff score of ≥7 was 32.9%, and those drinking soda were 1.7 times more likely to have GERD (95% confidence interval, 1.3-2.2; p<0.001). However, soda consumption was not a risk factor for development of GERD symptoms. Applying a cutoff score of ≥8, only 10.9% of the participants had a positive GERD score, but the association with soda consumption persisted. The median PGSQ-A score in subjects suspected of GERD was 8 (range 0-37) on weekends and 1 (range 0-17) during weekdays (p<0.001) compared to those not suspected of GERD, with a median of 2 (range 0-27) during weekends and 0 (range 0-10) during weekdays. Heartburn, regurgitation, and extraesophageal symptoms correlated significantly with QoL (p<0.001).
CONCLUSION
The prevalence of suspected GERD in adolescents was 32.9% or 10.9%, depending on the cutoff score used. There was a statistically significant difference in PGSQ-A scores between the subjects suspected or not of GERD, indicating an impaired QoL.

Keyword

Gastroesophageal reflux disease; Questionnaire; Quality of life; Adolescent

MeSH Terms

Adolescent*
Drinking
Gastroesophageal Reflux*
Heartburn
Humans
Incidence
Prevalence
Quality of Life
Risk Factors
Self-Assessment

Figure

• 

  Fig. 1 Comparison of PGSQ-A score between subjects suspected and not suspected of having GERD. (A) Weekends. (B) Schooldays. PGSQ-A: Pediatric Gastroesophageal Reflux Disease Symptom Questionnaire and Quality of Life Questionnaire, GERD: gastroesophageal reflux disease.

Reference

1. Nelson SP, Chen EH, Syniar GM, Christoffel KK. Pediatric Practice Research Group. Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Arch Pediatr Adolesc Med. 2000; 154:150–154.

2. El-Serag HB, Sweet S, Winchester CC, Dent J. Systematic review: update of gastro-oesophageal reflux disease. Gut. 2014; 63:871–880.

3. Hegar B, Vandenplas Y. Evaluation and management of the pediatric patients with suspected gastroesophageal reflux disease. Indones J Gastroenterol Hepatol Dig Endosc. 2011; 12:171–178.

4. Hegar B, Mulyani L. Esofagitis refluks pada anak. Sari Pediatri. 2006; 8:43–52.

5. Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009; 49:498–547.

6. Jones R, Junghard O, Dent J, Vakil N, Halling K, Wernersson B, et al. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther. 2009; 30:1030–1038.

7. Chiu JY, Wu JF, Ni YH. Correlation between gastroesophageal reflux disease questionnaire and erosive esophagitis in school-aged children receiving endoscopy. Pediatr Neonatol. 2014; 55:439–443.

8. Irvine EJ. Quality of life assessment in gastro-oesophageal reflux disease. Gut. 2004; 53:Suppl 4. iv35–iv39.

9. Kleinman L, Nelson S, Kothari-Talwar S, Roberts L, Orenstein SR, Mody RR, et al. Development and psychometric evaluation of 2 age-stratified versions of the Pediatric GERD Symptom and Quality of Life Questionnaire. J Pediatr Gastroenterol Nutr. 2011; 52:514–522.

10. Jonasson C, Wernersson B, Hoff DA, Hatlebakk JG. Validation of the GerdQ questionnaire for the diagnosis of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2013; 37:564–572.

11. Syam AF, Sobur CS, Hapsari FC, Abdullah M, Makmun D. Prevalence and risk factors of GERD in Indonesian population - an internet-based study. Adv Sci Lett. 2017; 23:6734–6738.

12. Okimoto E, Ishimura N, Morito Y, Mikami H, Shimura S, Uno G, et al. Prevalence of gastroesophageal reflux disease in children, adults, and elderly in the same community. J Gastroenterol Hepatol. 2015; 30:1140–1146.

13. Martigne L, Delaage PH, Thomas-Delecourt F, Bonnelye G, Barthélémy P, Gottrand F. Prevalence and management of gastroesophageal reflux disease in children and adolescents: a nationwide cross-sectional observational study. Eur J Pediatr. 2012; 171:1767–1773.

14. Borrelli O, Marabotto C, Mancini V, Aloi M, Macrì F, Falconieri P, et al. Role of gastroesophageal reflux in children with unexplained chronic cough. J Pediatr Gastroenterol Nutr. 2011; 53:287–292.

15. Madanick RD. Management of GERD-related chronic cough. Gastroenterol Hepatol (N Y). 2013; 9:311–313.

16. Phipps CD, Wood WE, Gibson WS, Cochran WJ. Gastroesophageal reflux contributing to chronic sinus disease in children: a prospective analysis. Arch Otolaryngol Head Neck Surg. 2000; 126:831–836.

17. Hanna BC, Wormald PJ. Gastroesophageal reflux and chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2012; 20:15–18.

18. Sone M, Yamamuro Y, Hayashi H, Niwa Y, Nakashima T. Otitis media in adults as a symptom of gastroesophageal reflux. Otolaryngol Head Neck Surg. 2007; 136:19–22.

19. Turk H, Hauser B, Brecelj J, Vandenplas Y, Orel R. Effect of proton pump inhibition on acid, weakly acid and weakly alkaline gastro-esophageal reflux in children. World J Pediatr. 2013; 9:36–41.

20. Thakkar K, Boatright RO, Gilger MA, El-Serag HB. Gastroesophageal reflux and asthma in children: a systematic review. Pediatrics. 2010; 125:e925–30.

21. McCallister JW, Parsons JP, Mastronarde JG. The relationship between gastroesophageal reflux and asthma: an update. Ther Adv Respir Dis. 2011; 5:143–150.

22. Blondeau K, Mertens V, Dupont L, Pauwels A, Farré R, Malfroot A, et al. The relationship between gastroesophageal reflux and cough in children with chronic unexplained cough using combined impedance-pH-manometry recordings. Pediatr Pulmonol. 2011; 46:286–294.

23. Johnson T, Gerson L, Hershcovici T, Stave C, Fass R. Systematic review: the effects of carbonated beverages on gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2010; 31:607–614.

24. Kohata Y, Fujiwara Y, Watanabe T, Kobayashi M, Takemoto Y, Kamata N, et al. Long-term benefits of smoking cessation on gastroesophageal reflux disease and health-related quality of life. PLoS One. 2016; 11:e0147860.

25. Chang CH, Wu CP, Wang JD, Lee SW, Chang CS, Yeh HZ, et al. Alcohol and tea consumption are associated with asymptomatic erosive esophagitis in Taiwanese men. PLoS One. 2017; 12:e0173230.

26. Acierno SP, Chilcote HC, Edwards TC, Goldin AB. Development of a quality of life instrument for pediatric gastroesophageal reflux disease: qualitative interviews. J Pediatr Gastroenterol Nutr. 2010; 50:486–492.

27. Gisbert JP, Cooper A, Karagiannis D, Hatlebakk J, Agréus L, Jablonowski H, et al. Impact of gastroesophageal reflux disease on patients' daily lives: a European observational study in the primary care setting. Health Qual Life Outcomes. 2009; 7:60.

28. Gong EJ, Choi KD, Jung HK, Youn YH, Min BH, Song KH, et al. Quality of life, patient satisfaction, and disease burden in patients with gastroesophageal reflux disease with or without laryngopharyngeal reflux symptoms. J Gastroenterol Hepatol. 2017; 32:1336–1340.

29. Pao M, Bosk A. Anxiety in medically ill children/adolescents. Depress Anxiety. 2011; 28:40–49.

30. Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet. 2012; 379:1056–1067.