Use of the Montreal Global Definition as an Assessment of Quality of Life in Reflux Disease
Bibliographic record
Abstract
Purpose: According to the Montreal Group's Classification, GERD develops when the reflux of stomach contents causes troublesome symptoms and/or complications such as esophagitis. The characteristic GERD symptoms included in this statement are retrosternal burning and regurgitation. Troublesome is meant to imply that these symptoms impact on the well-being of affected individuals; in essence, quality of life. We sought to determine whether heartburn and regurgitation symptoms would be characterized as more troublesome in those with confirmed pathologic acid reflux. A second purpose was to assess how well troublesome scores correlated with the results of a validated, disease-specific quality of life instrument. Methods: We interviewed subjects who underwent EGD with 48 hour wireless esophageal pH testing off PPI therapy. Esophagitis on EGD or pH < 4.0 for ≥ 4.5% of time over the two day period was considered positive for acid reflux. We assessed how troublesome their symptoms of heartburn and regurgitation were using separate 0-100 visual analog scales. We then asked them to complete the Quality of Life in Reflux and Dyspepsia (QOLRAD) 25- item questionnaire. Results: We identified 67 patients (21M, 46 F); mean age 47.8 ± 15.6 years. Forty (59.7%) had an EGD or pH study positive for acid reflux. Overall 35/40 (87.5%) complained of either heartburn or regurgitation. There was no difference (P = 0.80) in heartburn VAS troublesome ratings for those with (54.0 ± 43.9) and without (56.7 ± 37.6) confirmed acid reflux. The same was true for regurgitation VAS troublesome ratings (P = 0.62). Likewise, mean QOLRAD scores did not differ between those with and without confirmed acid reflux by pH or EGD (4.5 ± 1.7 vs. 4.3 ± 1.7; p = 0.61). There was a strong inverse correlation between patient self-rated VAS troublesome scores for both heartburn and regurgitation with each dimension (Emotional Distress, Sleep Disturbance, Eating Problems, Physical/Social Functioning, and Vitality) of the QOLRAD (p < 0.05 for all comparisons). In regression analysis, both heartburn and regurgitation troublesome ratings were associated with the overall QOLRAD score independent of pH data, frequency of reflux episodes, age, and gender. Conclusion: Use of the term troublesome in the Montreal Classification is supported by our findings. It correlates well with the results of a validated diseasespecific quality of life instrument. Use of heartburn and regurgitation VAS may serve as accurate measures of the burden of reflux disease on patients. It is likely that these scales will not have sufficient discriminate value to identify individuals with pathologic acid reflux from those with negative studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".