title: [Diagnostic usefulness of the Carlsson-Dent questionnaire in gastroesophageal reflux disease (GERD)].
abstract: 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).
  
  
  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.
authors.affiliation: Laboratorio de Motilidad Gastrointestinal, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), México, D. F.
authors.forename: Octavio
authors.initials: O
authors.lastname: Gómez-Escudero
authors.forename: José María
authors.initials: JM
authors.lastname: Remes-Troche
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Ruíz
authors.forename: Mario
authors.initials: M
authors.lastname: Peláez-Luna
authors.forename: Max Julio
authors.initials: MJ
authors.lastname: Schmulson
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Valdovinos Díaz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires