Patient symptoms correlate poorly with objective measures among patients with gastroesophageal reflux disease

Presentation of gastroesophageal reflux disease (GERD) varies among patients. To attempt to understand the patient's perception of the severity of their reflux symptoms, we developed a questionnaire on which patients rated symptom severity at each office visit. After receiving Institutional Review Board approval, we retrospectively reviewed patient charts of all patients seen by one surgeon for GERD symptoms and/or presence of hiatal hernia (HH) from September 2012 to April 2013. Data from patient questionnaires combined with objective findings from subsequent or prior workup and eventual operative information were recorded. A total of 144 questionnaires were reviewed from 108 patients. Frequencies were calculated for categorical variables. Patients were divided into four categories based on size of the HH on the endoscopic report; 10 patients had no HH, 15 had small HH, 20 had medium HH, and 31 patients had large HH. Size of HH was not available for three patients. Pre- and postoperative questionnaire responses were obtained for 15 patients. A combined reflux score was calculated using the median for each symptom. Patient perception of severity of symptoms does not necessarily predict presence of pathological reflux or HH nor is there a perfect combination of symptoms to predict the presence of pathological reflux or HH based on our sample. The workup of this pathology must be comprehensive, and the confirmation of reflux is imperative when the diagnosis is unclear.