Review article: Gastro-oesophageal reflux disease--application of the concept of complete remission

Abstract

Background: Therapeutic success in the treatment of gastro-oesophageal reflux disease cannot be measured by endoscopic healing or symptomatic relief alone. Assessment of treatment efficacy should be based on symptomatic relief and endoscopic healing. As most questionnaires focus on heartburn, it is important to stress that there is more to gastro-oesophageal reflux disease than just heartburn. The 'complete remission' concept was recently introduced; an approach in which endoscopic appearances and symptomatic relief are integrated, thus allowing the full gastro-oesophageal reflux disease picture and its changes over time to be described in a simple and accurate manner. Complete remission is defined as the absence of both oesophagitis and symptoms. ReQuest, a relatively new questionnaire acceptable as a clinical endpoint in trials, seems to be of use in daily practice.

Aim: To review the utility of the ReQuest questionnaire.

Results: This questionnaire assesses the gastro-oesophageal reflux disease symptom profile using 67 symptom descriptions adapted from patients' view, doctors' view, clinical trials and from the literature. Individual symptoms are reduced to seven dimensions by factor analysis and expert consensus. This gives insight into multiple symptoms over time as well as individual patient profiles. ReQuest determines symptom relief using a gastro-oesophageal reflux disease symptom threshold. This unique concept allows the doctor to measure the time to first symptom relief and also to sustained symptom relief.

Conclusions: ReQuest makes it possible to evaluate the complete symptom spectrum in patients with non-erosive oesophageal reflux disease and gastro-oesophageal reflux disease. ReQuest is available for daily practice to use for comparability with regard to treatment efficacy.