Development of a refractory gastro‐oesophageal reflux score using an administrative claims database

Aliment Pharmacol Ther 2011; 34: 555–567 Summary Background Approximately one‐third of gastro‐oesophageal reflux disease (GERD) patients demonstrate refractory symptoms following treatment with proton pump inhibitor (PPI) therapy. Aim To develop a refractory GERD score that can be applied to predict patients’ healthcare utilisation. Methods We enrolled adults (≥18 years) with a diagnosis of GERD. Refractory GERD was evaluated on an 8‐point scale where 1 point was given for each of the following criteria: doubling, addition, or switching of GERD medication dose, receipt of a GERD‐related endoscopic procedure or surgery, or ≥3 GERD‐related outpatient visits. Refractory GERD was defined as the presence of two or more points. Results A total of 135 139 GERD patients (44% male) were analysed with a mean (±s.d.) age of 52.9 ± 15 years. The mean overall refractory GERD score was 1.12 ± 1.2 (range 0–8 on an 8‐point scale); 31% of patients had refractory GERD with a mean score of 2.56 ± 0.82. Among patients with refractory GERD, 31% doubled their GERD medication, 28% added a new GERD medication, 60% switched GERD medications, 54% had a GERD‐related procedure and 1% had a GERD‐related surgery. Patients with refractory GERD were more likely to be female (59% vs. 55%, P