• Nimish Vakil, Börje Wernersson, Lis Ohlsson, and John Dent.
• University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
• United European Gastroenterol J. 2014 Jun 1; 2 (3): 173-8.

BackgroundSymptomatically 'silent' gastro-oesophageal reflux disease (GORD) may be underdiagnosed.ObjectiveTo determine the prevalence of untreated GORD without heartburn and/or regurgitation in primary care.MethodsPatients 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.ResultsGORD 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.ConclusionsStructured 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.

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