Layperson Perception of Reflux-Related Symptoms

Jakob L Fischer; Anthony M Tolisano; Alvaro I Navarro; Lily Trinh; Waleed M Abuzeid; Ian M Humphreys; Nadeem A Akbar; Sharan Shah; John S Schneider; Charles A Riley; Edward D McCoul

doi:10.1002/oto2.51

Layperson Perception of Reflux-Related Symptoms

OTO Open. 2023 May 9;7(2):e51. doi: 10.1002/oto2.51. eCollection 2023 Apr-Jun.

Authors

Jakob L Fischer^{1

2}, Anthony M Tolisano^{1

2}, Alvaro I Navarro³, Lily Trinh³, Waleed M Abuzeid⁴, Ian M Humphreys⁴, Nadeem A Akbar⁵, Sharan Shah⁵, John S Schneider⁶, Charles A Riley^{1

2}, Edward D McCoul^{3

7}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery Walter Reed National Military Medical Center Bethesda Maryland USA.
² Department of Surgery Uniformed Services University of the Health Sciences Bethesda Maryland USA.
³ Department of Otolaryngology-Head and Neck Surgery Tulane University New Orleans Louisiana USA.
⁴ Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery University of Washington Seattle Washington USA.
⁵ Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery Albert Einstein College of Medicine Bronx New York USA.
⁶ Department of Otolaryngology-Head and Neck Surgery Washington University School of Medicine St. Louis Missouri USA.
⁷ Department of Otorhinolaryngology and Communication Sciences Ochsner Clinic Foundation New Orleans Louisiana USA.

Abstract

Objective: To assess for differences of intended meaning in the description of reflux-related symptoms among otolaryngology patients and clinicians.

Study design: Cross-sectional survey-based study.

Setting: Five tertiary, academic otolaryngology practices.

Methods: Between June 2020 and July 2022, a questionnaire consisting of 20 common descriptors of reflux-related symptoms within four domains (throat-, chest-, stomach-, and sensory-related symptoms) was completed by patients. Attending otolaryngologists at five academic medical centers then completed the same survey. The primary outcome was to assess differences in patient and clinician perceptions of reflux-related symptoms. Differences based on geographic location was a secondary outcome.

Results: A total of 324 patients and 27 otolaryngologists participated. Patients selected a median of six terms compared with 10.5 for otolaryngologists (p < .001). Otolaryngologists were more likely to select sensory symptoms (difference: 35.8%; 95% confidence interval [CI]: 19.2%, 52.4%), throat-related symptoms (32.4%; 21.2, 43.6%), and chest-related symptoms (12.4%; 8.8, 15.9). Otolaryngologists and patients were equally likely to consider stomach symptoms as related to reflux (4.0%, -3.7%, 11.7%). No significant differences were identified based on geographic location.

Conclusion: There are differences between otolaryngologists and their patients in the interpretation of the symptoms of reflux. Patients tended to have a narrower interpretation of reflux with symptoms primarily limited to classic stomach-related symptoms, while clinicians tended to have a broader definition of reflux that included extra-esophageal manifestations of disease. This has important counseling implications for the clinician, as patients presenting with reflux symptoms may not comprehend the relationship of those symptoms to reflux disease.

Keywords: GERD; definition of terms; gastro‐esophageal reflux disease; health literacy; patient‐provider communication; reflux; symptom; word‐association.