title: Do physicians correctly assess patient symptom severity in gastro-oesophageal reflux disease?
abstract: BACKGROUND
  The accuracy of physicians' assessment of the severity of gastro-oesophageal reflux disease is unclear.
  
  
  OBJECTIVE
  To correlate physician and patient assessment of gastro-oesophageal reflux disease severity and its response to treatment.
  
  
  METHODS
  Adult uninvestigated gastro-oesophageal reflux disease patients (n = 217) completed symptom and health-related quality of life questionnaires at baseline and after treatment with esomeprazole 40 mg p.o. daily. Pearson coefficients quantified correlations between physician assessments and patient responses.
  
  
  RESULTS
  At baseline, the strongest correlations were heartburn severity (0.31), overall symptom severity (0.44) and a domain of the quality of life in reflux and dyspepsia questionnaire (0.31) (P < 0.001). Correlations of change with treatment were greater than baseline correlations: heartburn (0.39), overall symptoms (0.50) and global rate of change -- stomach problems (0.72, all P < 0.001). The mean difference between the physicians' assessment of change and the patients' global rating of change was 0.20 (95% confidence intervals: 0.10-0.29) with physicians overestimating benefit.
  
  
  CONCLUSIONS
  Correlations were often significant, although weak to moderate and better with symptom severity than with health-related quality of life instruments as well as with change after therapy than at baseline. Increasing attention to health-related quality of life may help physicians better understand patients' experience. In clinical trials, treatment success should be assessed by the patient as well as the physician.
authors.affiliation: Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada. carlo.fallone@mcgill.ca
authors.forename: C A
authors.initials: CA
authors.lastname: Fallone
authors.forename: G H
authors.initials: GH
authors.lastname: Guyatt
authors.forename: D
authors.initials: D
authors.lastname: Armstrong
authors.forename: I
authors.initials: I
authors.lastname: Wiklund
authors.forename: A
authors.initials: A
authors.lastname: Degl'Innocenti
authors.forename: D
authors.initials: D
authors.lastname: Heels-Ansdell
authors.forename: A N
authors.initials: AN
authors.lastname: Barkun
authors.forename: N
authors.initials: N
authors.lastname: Chiba
authors.forename: S J O V
authors.initials: SJ
authors.lastname: Zanten
authors.forename: S
authors.initials: S
authors.lastname: El-Dika
authors.forename: P
authors.initials: P
authors.lastname: Austin
authors.forename: L
authors.initials: L
authors.lastname: Tanser
authors.forename: H J
authors.initials: HJ
authors.lastname: Schünemann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002983:Clinical Competence / Q000592:standards*; D004415:Dyspepsia / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000592:standards*; D011788:Quality of Life