title: Gastroesophageal and extraesophageal reflux symptoms: similarities and differences.
abstract: OBJECTIVE
  The association between extraesophageal reflux (EER) and symptoms of gastroesophageal reflux disease (GERD) is inadequately understood. We used the Comprehensive Reflux Symptom Scale (CReSS) to evaluate EER and reflux-symptom prevalence in gastroenterology and otolaryngology outpatients and symptom awareness among UK gastroenterologists.
  
  
  METHODS
  Cross-sectional cohort survey.
  
  
  METHODS
  Six hundred thirty-nine participants were surveyed: 103 controls, 359 patients undergoing esophagogastroduodenoscopy (EGD), and 177 otolaryngology clinic patients with throat symptoms. Participants completed the CReSS questionnaire. The study was undertaken in the Endoscopy Unit and the Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne, United Kingdom. Registered members of the British Gastroenterology Society were asked to rate how frequently reflux patients might complain of each CReSS item.
  
  
  RESULTS
  The median CReSS total in volunteers (4) was significantly lower (P < .002) than in ear, nose, and throat (ENT) patients (26) or EGD patients with (42) or without (32) esophageal inflammation. All items were scored as ≥1 by >15% of ENT patients and 28% of EGD patients. Three major, robust CReSS factors: esophageal, pharyngeal, and upper airway emerged. Of 259 gastroenterologists, >20% scored 8 of the 34 symptoms as never being reported by reflux patients.
  
  
  CONCLUSIONS
  Endorsement of each EER CReSS item by 28% to 58% of patients with endoscopic evidence of GERD supports the Montreal consensus on an EER-GERD continuum. Gastroenterologists vary considerably in their appreciation of EER symptom relevance. The advantages of CReSS include standardized, comprehensive capture of patient experience; discriminant validity of ENT and GERD patients from volunteers; and discrete esophageal, pharyngeal, and upper airway subscales.
  
  
  METHODS
  4.
authors.affiliation: Department of Medical Physics, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Drinnan
authors.forename: Jason
authors.initials: J
authors.lastname: Powell
authors.forename: Ali
authors.initials: A
authors.lastname: Nikkar-Esfahani
authors.forename: Robert C
authors.initials: RC
authors.lastname: Heading
authors.forename: Jill
authors.initials: J
authors.lastname: Doyle
authors.forename: S Michael
authors.initials: SM
authors.lastname: Griffin
authors.forename: Paula
authors.initials: P
authors.lastname: Leslie
authors.forename: Paula T
authors.initials: PT
authors.lastname: Bradley
authors.forename: Peter
authors.initials: P
authors.lastname: James
authors.forename: Janet A
authors.initials: JA
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D016145:Endoscopy, Digestive System; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology
keywords: Gastroesophageal reflux; extraesophageal reflux; gastrointestinal; patient reported outcomes