Symptom normalization, care-seeking delay, and health-related quality of life in adults with gastroesophageal reflux disease: a cross-sectional study

Abstract

Gastroesophageal reflux disease (GERD) is associated with significant physical, psychological, and functional impairment. Although patients frequently normalize reflux symptoms and postpone medical consultation, the extent to which these behaviors influence symptom burden and health-related quality of life (HRQoL) remains unclear. This study evaluated the associations between prespecified Symptom Normalization and Care-Seeking Delay conceptual domain scores, GERD symptom severity, and HRQoL in adults with GERD. A cross-sectional study was conducted among 218 adults with physician-established diagnosis of GERD attending King Khalid University Medical City and affiliated primary healthcare centers in Abha, Saudi Arabia. Data were collected using Gastroesophageal Reflux Disease Questionnaire (GerdQ), GERD-HRQoL, and prespecified conceptual domain scores for symptom normalization and care-seeking delay, and analyzed using correlation and regression methods. A total of 218 participants were included, with the majority being female (87.6%) and aged 18–40 years (49.0%). Among participants with physician-established GERD, 33.5% had GerdQ scores ≥8, indicating higher symptom burden. GERD symptom severity showed a strong positive correlation with GERD-HRQoL scores ( ρ  = 0.704, p  < 0.001), indicating poorer quality of life with greater symptom burden. The prespecified Symptom Normalization and Care-Seeking Delay conceptual domain scores were strongly correlated with each other ( ρ  = 0.734, p  < 0.001), while both showed weak correlations with GERD symptom severity. In multivariable linear regression, GerdQ score was the only variable significantly associated with GERD-HRQoL (B = 0.971, 95% CI: 0.808–1.134, p  < 0.001), and the model explained 50.6% of the variance in GERD-HRQoL scores (R 2  = 0.506; adjusted R 2  = 0.472). The prespecified Symptom Normalization and Care-Seeking Delay conceptual domain scores were not statistically significantly associated with GERD-HRQoL after adjustment. Among adults with physician-established GERD, greater current symptom burden was independently associated with poorer HRQoL, while higher Symptom Normalization conceptual domain scores were strongly associated with higher Care-Seeking Delay conceptual domain scores. These findings suggest that symptom appraisal and healthcare-seeking behaviors should be considered alongside symptom severity when evaluating the overall burden of GERD.