title: Prevalence of gastro-oesophageal reflux disease with upper gastrointestinal symptoms without heartburn and regurgitation.
abstract: BACKGROUND
  Symptomatically 'silent' gastro-oesophageal reflux disease (GORD) may be underdiagnosed.
  
  
  OBJECTIVE
  To determine the prevalence of untreated GORD without heartburn and/or regurgitation in primary care.
  
  
  METHODS
  Patients were included if they had frequent upper gastrointestinal symptoms and had not taken a proton pump inhibitor in the previous 2 months (Diamond study: NCT00291746). GORD was diagnosed based on the presence of reflux oesophagitis, pathological oesophageal acid exposure, and/or a positive symptom-acid association probability. Patients completed the Reflux Disease Questionnaire (RDQ) and were interviewed by physicians using a prespecified symptom checklist.
  
  
  RESULTS
  GORD was diagnosed in 197 of 336 patients investigated. Heartburn and/or regurgitation were reported in 84.3% of patients with GORD during the physician interviews and in 93.4% of patients with GORD when using the RDQ. Of patients with heartburn and/or regurgitation not identified at physician interview, 58.1% (18/31) reported them at a 'troublesome' frequency and severity on the RDQ. Nine patients with GORD did not report heartburn or regurgitation either at interview or on the RDQ.
  
  
  CONCLUSIONS
  Structured patient-completed questionnaires may help to identify patients with GORD not identified during physician interview. In a small proportion of consulting patients, heartburn and regurgitation may not be present in those with GORD.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Nimish
authors.initials: N
authors.lastname: Vakil
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden.
authors.forename: Börje
authors.initials: B
authors.lastname: Wernersson
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden.
authors.forename: Lis
authors.initials: L
authors.lastname: Ohlsson
authors.affiliation: Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Dent
keywords: Bloating; gastro-oesophageal reflux disease; heartburn; oesophageal endoscopy; oesophageal pH monitoring; regurgitation; upper abdominal pain