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Digestion
2005;71:145151
DOI: 10.1159/000085564
Published online: May 4, 2005
Determination of ReQuest-Based
Symptom Thresholds to Defi ne Symptom
Relief in GERD Clinical Studies
Vincenzo Stanghellini
c
a
Peter Berghfer
David Armstrong
Gudrun Gatz
Hubert Mnnikes
Key Words
Gastroesophageal refl ux disease
Symptom
thresholds, GERD Symptom evaluation,
GERD-related ReQuest Refl ux questionnaire
Gastrointestinal
Symptom
Rating
Scale
Psychological
General Well-Being scale
Rating Scale, and the Psychological General WellBeing scale. On the other days, participants fi lled in
Abstract
the ReQuest only. GERD symptom thresholds were
Background/Aims: The growing importance of
calculated for ReQuest and its subscales, based
symptom assessment is evident from the numerous
on the respective 90th percentiles. Results: GERD
clinical studies on gastroesophageal refl ux disease
symptom thresholds were 3.37 for ReQuest, 0.95
(GERD) assessing treatment-induced symptom
for ReQuestGI, and 2.46 for ReQuest-WSO.
relief. However, to date, the a priori selection of
Conclusion: Even individuals without evidence of
criteria defi ning symptom relief has been arbitrary.
GERD may experience some mild symptoms that
The present study was designed to prospectively
are commonly ascribed to GERD. GERD symptom
identify GERD symptom thresholds for the broad
thresholds derived in this study can be used to defi
spectrum of GERD-related symptoms assessed by
ne the global symptom relief in patients with GERD.
the validated refl ux questionnaire (ReQuest) and
its
subscales,
ReQuest-GI
(gastrointestinal
Copyright 2005 S. Karger AG, Basel
symptoms) and ReQuest-WSO (general well-being,
sleep disturbances, other complaints), in individuals
without evidence of GERD. Methods: In this 4-day
evaluation in Germany, 385 individuals without
Introduction
146
ReQuest
ReQuest is a self-assessed, dimension-orientated scale
designed to evaluate the treatment response in patients suffering
from erosive GERD or enGERD on a frequent, e.g. daily, basis.
ReQuest has been validated in GERD and enGERD both
nationally and internationally [ 79] . It comprises a short and a long
version; both versions assess seven dimensions of GERD (acid complaints, upper abdominal/stomach complaints, lower abdominal/
digestive complaints, nausea, sleep disturbances, other complaints
and general well-being). The intensity is measured on a 100-mm
visual analogue scale and the frequency (except general well-being)
on a 7-point Likert scale, ranging from 0 to more than 10 times per
day. Additionally, the long version asks for the occurrence of
symptom descriptions known to be typical of the corresponding
dimension.
Two validated subscales of ReQuest exist: ReQuest-GI and
ReQuest-WSO. ReQuest-GI comprises the dimensions of acid
complaints,
upper
abdominal/stomach
complaints,
lower
abdominal/digestive complaints and nausea, while ReQuest-WSO
comprises general well-being, sleep disturbances and other
complaints. The minimum sum score for ReQuest and its
subscales is 0. The maximum sum score for ReQuest is 46.28. For
ReQuest-GI and ReQuest-WSO, the maximum sum scores are
30.77 and
15.51, respectively.
Alcohol consumption
Daily
Never/occasional
Parameter
Male
Female
Gender
Mean age, years
Mean height, cm
Mean weight, kg
Mean body mass index, kg/m2
146 (37.9%)
40.6813.6
180.587.1
82.4817.3
25.385.1
239 (62.1%)
38.2812.3
167.786.2
65.5813.0
23.384.2
Smoking behavior
Daily smoker
Occasional smoker
Non-smoker
70 (18.2%)
43 (11.2%)
271 (70.6%)
25 (6.5%)
360 (93.5%)
Results
147
Table 2.
Empirical
percentile
ReQuest
90th 3.37
0.95
91st
92nd
93rd
94th
95th
96th
97th
98th
99th
2.46
3.62
4.09
4.48
4.88
5.04
5.69
6.53
7.62
9.54
1.12
1.29
1.38
1.53
1.73
2.24
2.40
3.60
4.39
2.64
3.11
3.23
3.33
3.68
4.20
4.71
5.49
6.52
Score
Digestion 2005;71:145151
Discussion
149
References
150
Digestion 2005;71:145151
Stanghellini/Armstrong/Mnnikes/
Berghfer/Gatz/Bardhan
How to diagnose gastroesophageal refl 4 Moss SF, Armstrong D, Arnold R, Ferenci P, Fock 6 Armstrong D, Mnnikes H, Bardhan KD,
t 1. Diagnostic value of symptoms.
KM, Holtmann G, McCarthy DM, Moraes-Filho
Stanghellini V: The construction of a new
ation and role of endoscopy (in French).
JP, Mutschler E, Playford R, Spechler SJ,
evaluative GERD questionnaire Methods and
nterol Clin Biol 1999; 23: S202S207.
Stanghellini V, Modlin IM: GERD 2003 A
state of the art. Digestion 2004; 70: 7178.
K, Glise H: Quality of life in differ-ent
consensus on the way ahead. Digestion 2003; 67: 7 Bardhan KD, Stanghellini V, Armstrong D, Berghfer
111117.
estinal conditions. Eur J Surg 1998;
P, Gatz G, Mnnikes H: Evaluation of GERD
5 Stanghellini V, Armstrong D, Mnnikes H, Bardhan
pl):5661.
symptoms during therapy. Part I. Development of
n J, Fendrick AM, Fennerty MB, Janssens
KD: Systematic review: Do we need a new gastrothe new GERD questionnaire ReQuest.
oesophageal refl ux disease questionnaire?
Digestion 2004; 69: 229237.
las PJ, Lauritsen K, Reynolds JC, Shaw
Aliment Pharmacol Ther 2004; 19:
8 Mnnikes H, Bardhan KD, Stanghellini V, Berghfer
ey NJ, on the behalf of the Genval
463479.
p Group: An evidence-based appraisal of
P, Bethke TD, Armstrong D: Evaluation of GERD
disease management The Genval
symptoms during therapy. Part II. Psychometric
p Report. Gut 1999; 44(suppl
evaluation and validation of the new questionnaire
S16.
ReQuest in erosive GERD. Digestion 2004; 69:
238244.
9Bardhan KD, Stanghellini V, Armstrong D, Berghfer
P, Gatz G, Mnnikes H: International validation
of ReQuest in patients with endoscopy
negative gastroesophageal refl ux disease.
Aliment Pharmacol Ther 2004; 20: 891898.
10 Castell DO, Kahrilas PJ, Richter JE, Vakil NB,
Johnson DA, Zuckermann S, Skammer W,
Levine JG: Esomeprazole (40 mg) compared
with lansoprazole (30 mg) in the treatment of
erosive esophagitis. Am J Gastroenterol 2002;
97: 575583.
11 Talley NJ, Lauritsen K, Tunturi-Hihnala H, Lind
T, Moum B, Bang C, Schulz T, Omland TM,
Delle M, Junghard O: Esomeprazole 20 mg
maintains symptom control in endoscopynegative gastro-oesophageal refl ux disease: A
controlled trial of on-demand therapy for 6
months. Aliment Pharmacol Ther 2001;
15: 347354.
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Symptom Thresholds
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