Diagnostic accuracy of gastroesophageal reflux disease questionnaire for gastroesophageal reflux disease: A systematic review and meta-analysis

Background: The use of a symptom-based gastroesophageal reflux disease (GERD) questionnaire (GerdQ) for GERD diagnosis has gained interest due to its greater efficacy and ease of use than other available questionnaires. However, different guidelines have given inconsistent recommendations regarding using GerdQ as a diagnostic test. This meta-analysis summarized the diagnostic accuracy of GerdQ for diagnosing GERD. Methods: Studies published up to April 12, 2023, and indexed in MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library were searched. Diagnostic test accuracy studies comparing GerdQ with upper endoscopy and/or pH-metry for GERD diagnosis in adult patients with symptoms suggestive of GERD were included. The study quality was assessed using the QUADAS-2 tool. Meta-analysis using bivariate (Reitsma) analysis was done to summarize the overall sensitivity, specificity, likelihood ratios (LRs), and diagnostic odds ratio (DOR). The summary receiver operating characteristics (SROC) curve was visualized, and the area under the ROC (AUC) was calculated. Key Results: A total of 13 studies with 11,166 participants were included in the meta-analysis. The pooled sensitivity, specificity, positive LR, negative LR, and DOR for GerdQ (cut-off value of ≥8) were 66.9% (95% CI 56.4%–73.1%), 65.2% (95% CI 56.4%–73.1%), 1.93 (95% CI 1.55–2.42), 0.51 (95% CI 0.38–0.66), and 3.89 (95% CI 2.44–5.89), respectively. The overall AUC from the SROC was 0.705. The subgroup analysis showed similar pooled sensitivity, specificity, and DOR between Asian and non-Asian studies. Conclusions & Inferences: GerdQ had moderate sensitivity and specificity for GERD diagnosis. GerdQ can still be recommended as a diagnostic tool for GERD, especially when the PPI test is unavailable or contraindicated.