Observer Bias May Be Increasing GERD Diagnoses

An “observer bias” that leads doctors to interpret upper gastrointestinal (GI) symptoms as signs of gastroesophageal reflux disease (GERD) rather than other conditions such as functional dyspepsia has led to a dramatic increase in GERD diagnoses, a study finds. (Functional dyspepsia, which is also associated with upper GI distress, can be difficult to distinguish from GERD.) The study, conducted by Mayo Clinic researchers along with colleagues in the United States, Europe, and Australia, was presented last week at the American College of Gastroenterology 2011 Annual Scientific Meeting.

The study found that GERD diagnoses have increased from 325 per 100,000 patients in 1985 to 1,866 per 100,000 patients in 2009, while GERD symptoms have decreased from 12% during 1988-1994 to 7.6% in 2008-2009. When symptoms of both GERD and functional dyspepsia are present, GERD was diagnosed 45% of the time. Even when only symptoms of functional dyspepsia were present, GERD was still the most likely diagnosis, identified along with functional dyspepsia 50% of the time.

In an interview with HCPLive at the ACG meeting, the study's senior author G. Richard Locke, MD, a Mayo Clinic gastroenterologist, explained that those misdiagnosed with GERD may end up undergoing fundoplication surgery that is inappropriate for their condition. (HCPLive also spoke with Christopher Pleyer, MD, of the Mayo Clinic, on the same topic. To see our interview with him, click here.)