Development and validation of a new questionnaire for the evaluation of upper gastrointestinal symptoms in the elderly population: a multicenter study.

BACKGROUND Several diagnostic questionnaires for evaluating upper gastrointestinal symptoms have been described; none of these, however, has been validated in older individuals. Objectives To develop and validate a diagnostic tool for evaluating upper gastrointestinal symptoms in older patients. METHODS A cohort of 206 older patients who underwent a upper gastrointestinal endoscopy (development cohort) was used for developing a 15-item upper gastrointestinal symptom questionnaire for the elderly population (UGISQUE), including five symptom clusters: (a) abdominal pain syndrome, (b) reflux syndrome, (c) indigestion syndrome, (d) bleeding, and (e) nonspecific symptoms. The questionnaire was then validated in a cohort of 326 older patients selected from those who underwent an upper gastrointestinal endoscopy in 15 gastroenterological centers in Italy (validation cohort). RESULTS The endoscopic diagnoses in the development and validation cohorts were esophagitis (E) 15.5% and 29.4%, erosive gastritis (EG) 24.8% and 24.8%, peptic ulcer (PU) 26.2% and 14.7%, and without organic lesions (WOL) 31.0% and 33.5%, respectively. In both the cohorts, patients with upper gastrointestinal disorders showed significantly more symptoms than WOL patients. The predictive value of UGISQUE for any pathological condition (E, EG, or PU) was good, with areas under the receiver-operating characteristic curve of .80, 95% confidence interval (CI) 0.743-0.864, and of .78, 95% CI 0.73-0.83, in the development and validation cohorts, respectively. The accuracy of UGISQUE was significantly higher than that for the individual clusters of symptoms in predicting the presence of E (p = .004), PU (p < .0001), or any pathological condition (p < .0001). CONCLUSION UGISQUE is an accurate diagnostic tool for evaluating symptoms in elderly patients with upper gastrointestinal disorders.

[1]  D. Seripa,et al.  Comparison of four proton pump inhibitors for the short-term treatment of esophagitis in elderly patients. , 2007, World journal of gastroenterology.

[2]  D. Seripa,et al.  Clinical Features of Reflux Esophagitis in Older People: A Study of 840 Consecutive Patients , 2006, Journal of the American Geriatrics Society.

[3]  R. Hunt,et al.  Peptic ulcer disease today , 2006, Nature Clinical Practice Gastroenterology &Hepatology.

[4]  P. Moayyedi,et al.  Symptom-Based Outcome Measures for Dyspepsia and GERD Trials: A Systematic Review , 2005, The American Journal of Gastroenterology.

[5]  A. Andriulli,et al.  Proton‐pump inhibitors reduce the risk of uncomplicated peptic ulcer in elderly either acute or chronic users of aspirin/non‐steroidal anti‐inflammatory drugs , 2004, Alimentary pharmacology & therapeutics.

[6]  M. Horowitz,et al.  Development and validation of the Diabetes Bowel Symptom Questionnaire , 2003, Alimentary pharmacology & therapeutics.

[7]  J. Morley.  Anorexia and weight loss in older persons. , 2003, The journals of gerontology. Series A, Biological sciences and medical sciences.

[8]  C. Manterola,et al.  Initial validation of a questionnaire for detecting gastroesophageal reflux disease in epidemiological settings. , 2002, Journal of clinical epidemiology.

[9]  P. Malfertheiner,et al.  Peptic ulcer disease , 2002, The Lancet.

[10]  S. Fullerton,et al.  Identifying Patients with Gastroesophageal Reflux Disease: Validation of a Practical Screening Tool , 2002, Digestive Diseases and Sciences.

[11]  P. Malfertheiner,et al.  An approach to Helicobacter pylori infection in the elderly , 2002, Alimentary pharmacology & therapeutics.

[12]  S. Dedhiya,et al.  Reliability, validity, and responsiveness of Severity of Dyspepsia Assessment (SODA) in a randomized clinical trial of a COX-2-specific inhibitor and traditional NSAID therapy , 2002, American Journal of Gastroenterology.

[13]  S. Weingarten,et al.  Identifying patients with gastroesophageal reflux disease in a managed care organization. , 2001, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[14]  W. Stewart,et al.  Symptoms Associated with Gastroesophageal Reflux Disease , 2001, Digestive Diseases and Sciences.

[15]  G. O'Mara,et al.  Absence of abdominal pain in older persons with endoscopic ulcers: a prospective study , 2001, American Journal of Gastroenterology.

[16]  A. Fendrick,et al.  Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease , 2001, American Journal of Gastroenterology.

[17]  M. Anvari,et al.  Reproducibility, validity, and responsiveness of a disease-specific symptom questionnaire for gastroesophageal reflux disease. , 2000, Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus.

[18]  A. Blum,et al.  Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification , 1999, Gut.

[19]  P J Garry,et al.  The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. , 1999, Nutrition.

[20]  P. Moayyedi,et al.  The Leeds Dyspepsia Questionnaire: a valid tool for measuring the presence and severity of dyspepsia , 1998, Alimentary pharmacology & therapeutics.

[21]  Y. Kinoshita,et al.  Relationship between severity and symptoms of reflux oesophagitis in elderly patients in Japan , 1998, Journal of gastroenterology and hepatology.

[22]  E. El-Omar,et al.  The Glasgow Dyspepsia Severity Score – a tool for the global measurement of dyspepsia , 1996, European journal of gastroenterology & hepatology.

[23]  A. Zinsmeister,et al.  A new questionnaire for gastroesophageal reflux disease. , 1994, Mayo Clinic proceedings.

[24]  I. Räihä,et al.  Symptoms of gastro-oesophageal reflux disease in elderly people. , 1991, Age and ageing.

[25]  X. Vidal,et al.  Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs , 1991, The Lancet.

[26]  E. DeLong,et al.  Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. , 1988, Biometrics.

[27]  J. Svedlund,et al.  GSRS—A clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease , 1988, Digestive Diseases and Sciences.

[28]  G. Watkinson,et al.  Peptic ulcer disease , 1985, Digestive Diseases and Sciences.

[29]  J. Hanley,et al.  A method of comparing the areas under receiver operating characteristic curves derived from the same cases. , 1983, Radiology.

[30]  E. Pfeiffer.  A Short Portable Mental Status Questionnaire for the Assessment of Organic Brain Deficit in Elderly Patients † , 1975, Journal of the American Geriatrics Society.

[31]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .

[32]  I. Wiklund,et al.  Reliability and validity of the gastrointestinal symptom rating scale in patients with gastroesophageal reflux disease , 2004, Quality of Life Research.

[33]  S. Dedhiya,et al.  Reliability, validity, and responsiveness of severity of dyspepsia assessment (SODA) in a randomized clinical trial of a COX-2-specific inhibitor and traditional NSAID therapy. , 2002 .

[34]  P. Cotton,et al.  Practical Gastrointestinal Endoscopy , 2000 .

[35]  I. Wiklund,et al.  Validation of seven graded diary cards for severity of dyspeptic symptoms in patients with non ulcer dyspepsia. , 1998, The European journal of surgery. Supplement. : = Acta chirurgica. Supplement.

[36]  J. Dent,et al.  The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease. , 1998, Scandinavian journal of gastroenterology.

[37]  T. Halvorsen,et al.  Hiatus hernia in gastroesophageal reflux disease. , 1986, Scandinavian journal of gastroenterology.