Validation of a symptom diary for patients with gastro-oesophageal reflux disease.
BACKGROUND
Symptom diaries are potentially attractive but, because of concerns about patient compliance, they have had limited use in clinical trials. We assessed the validity and responsiveness of a symptom diary for patients with gastro-oesophageal reflux disease.


METHODS
We included 215 patients with gastro-oesophageal reflux disease after starting treatment for 4 weeks with 40 mg esomeprazole once daily. Patients recorded whether they experienced night-time heartburn (yes/no), the severity of daytime heartburn on a scale from 1 (no heartburn) to 4 (severe heartburn) and their antacid use. Patients also completed a number of disease-specific and preference-based Health-related Quality of Life questionnaires at baseline and follow-up.


RESULTS
Consistent with a priori predictions, daytime heartburn showed moderate to strong correlations with the Quality of Life in Reflux and Dyspepsia questionnaire (0.36-0.67) and four scales of symptom severity (0.36-0.70) for baseline, follow-up and change scores, but low correlations with the Standard Gamble. Responsiveness of the daytime heartburn item was excellent with a mean change from baseline to follow-up of -1.3 (95% CI -1.4 to -1.1) and a standardized response mean of 1.33 while responsiveness of the daily antacid use item was moderate (mean change scores -1.8 tablets taken, 95% CI -2.3 to -1.3 and standardized response mean of 0.64).


CONCLUSIONS
The excellent psychometric properties of this simple gastro-oesophageal reflux disease diary make it an attractive measure for future trials.
Puhan
M A
MA
Horten Centre, University of Zurich, Switzerland.
Guyatt
G H
GH
Armstrong
D
D
Wiklund
I
I
Fallone
C A
CA
Heels-Ansdell
D
D
Degl'Innocenti
A
A
Veldhuyzen van Zanten
S J O
SJ
Tanser
L
L
Barkun
A N
AN
Chiba
N
N
Austin
P
P
El-Dika
S
S
Schünemann
H J
HJ
D000863:Antacids / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D064098:Esomeprazole / Q000627:therapeutic use; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy; D006356:Heartburn / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000863:Antacids; D000897:Anti-Ulcer Agents; D064098:Esomeprazole