Assessing symptoms in gastroesophageal reflux disease: how well do clinicians' assessments agree with those of their patients?

OBJECTIVES: This study aimed to determine the extent of agreement between clinicians and patients regarding assessments of reflux symptom severity in patients with gastroesophageal reflux disease.
METHODS: Data were analyzed from four randomized clinical trials involving 2,674 patients treated with esomeprazole, omeprazole, ranitidine, or placebo. The extent of agreement was determined for symptom severity before and after 4-8 wk of treatment, and for the absence of symptoms after treatment. Agreement was further analyzed by determining weighted kappa values, which were interpreted according to the criteria of Landis and Koch.
RESULTS: Before treatment, clinician-patient agreement regarding symptom severity in the four studies was slight to moderate (kappa: 0.17-0.53); 48-52% of assessments agreed for heartburn, 24-35% for epigastric pain, 36-43% for regurgitation, and 63% agreed for dysphagia. Poor agreement reflected clinician underestimation of symptom severity relative to patient ratings in three studies and clinician overestimation in one study. Agreement regarding symptom severity improved following treatment, and was fair to substantial (kappa: 0.31-0.73); 58-78% of assessments agreed for heartburn, 42-60% for epigastric pain, 66-76% for regurgitation, and 86% agreed for dysphagia. After treatment, agreement was greatest for patients reporting absence of symptoms and decreased with increasing severity of symptoms.
CONCLUSIONS: The agreement between clinicians and patients in their assessments of the severity of reflux symptoms is poor, particularly before treatment and for more severe symptoms. Improvements in clinician-patient communication may help to bridge this gap, and greater reliance on patient assessments may be appropriate.