Abstracts
1997 Digestive Disease Week

Quality of life scores correlate poorly with subjective and objective measurements of gastroesophageal reflux.

TL Trus, WS Laycock, GD Branum, JP Waring, JG Hunter. Departments of Surgery and Medicine, Emory University Hospital, Atlanta, GA.

Subjective assessment of patient symptoms (i.e. symptom scores) and objective measurement of reflux using 24 hour ambulatory esophageal pH monitoring (24° pH) have traditionally been accepted as the methods of determining the response to antireflux surgery in patients with gastroesophageal reflux disease (GERD). The quality of life of patients with GERD often reflects lifestyle modifications which may not be measured by symptom scores and 24° pH. The Medical Outcome Study 36 item short form (SF-36) is a well validated questionnaire that measures eight specific health concepts in three general categories; functional status, general well being, and overall perception of health. We have previously shown significant improvements in SF-36 score, symptom scores, and 24° pH following laparoscopic antireflux surgery. The goal of this study was to determine if SF-36 scores correlate with subjective symptom scores of reflux and objective measurements of reflux by 24° pH, or if they represent an independent measure of success of therapy. Pre- and post-operative SF-36 questionnaires were completed by 133 patients. Individual preoperative SF-36 scores were plotted against preoperative symptom scores of chest pain, heartburn, regurgitation and dysphagia (0=none, 4=severe). Preoperative SF-36 scores were also plotted against preoperative 24° pH (% total time pH<4.0) in 36 patients. Similar comparisons were made between postoperative SF-36 scores, symptom scores and 24° pH. The correlation coefficient (CC) for each comparison was calculated. All preoperative SF-36 scores correlated poorly with symptom scores (CC range; -.061 to -.353). Similarly poor correlation was observed between preoperative SF-36 and 24° pH (CC range; -.17 to .114). Poor correlation was also observed in comparisons of individual postoperative SF-36 scores with symptom scores (CC range; -.493 to .082) and 24° pH (CC range; -.685 to .618). These data suggest that traditional assessments of symptom scores and 24 hour ambulatory esophageal pH monitoring do not reflect the patient's overall perception of their quality of life. Quality of life assessment is an independent measure of the success of therapy.