The importance of symptom assessment in the surgical treatment of gastroesophageal reflux disease and Barrett’s esophagus

Abstract

The "art" and science of symptom assessment in the evaluation of patients with gastroesophageal reflux disease has been under emphasized. In fact, it is critical to judgements regarding surgical versus non-surgical therapy and is much more difficult than meets the eye. Many symptoms thought to be secondary to gastroesophageal reflux are not, and some, such as asthma cough and chest pain, which are commonly thought secondary to other causes, are indeed symptoms of reflux. Diagnostic studies are helpful but far from perfect, ultimately requiring the clinician's expert judgement as the key factor in determining a successful outcome. The following outlines both an approach to the assessment of symptoms and when possible, clinical studies shedding light on their cause and interpretation.

Gastroesophageal reflux disease in diabetic patients: a systematic review

“…Autonomic NP with damage of efferent and afferent nerve fibers has been made responsible for this phenomenon and it was concluded that GERD questionnaires were not useful for diabetic patients [21]. However, one may criticize that both authors [11,21] used questionnaires which have not been validated and lack adequate reliability and responsiveness [22][23][24]. Similar results have been described for GERD symptoms in patients with DM type I, too [25].…”