Symptom normalization, care-seeking delay, and health-related quality of life in adults with gastroesophageal reflux disease: a cross-sectional study.
7 affiliations
- 1Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia.
- 2Department of Clinical Pharmacy, College of Pharmacy, Shaqra University, Dawadimi, Saudi Arabia.
- 3Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.
- 4Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia.
- 5King Saud University Medical City, Riyadh, Saudi Arabia.
- 6Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia.
- 7Department of Paediatrics, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia.
Abstract
Background
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.Methods
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.Results
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 (R² = 0.506; adjusted R² = 0.472). The prespecified Symptom Normalization and Care-Seeking Delay conceptual domain scores were not statistically significantly associated with GERD-HRQoL after adjustment.Conclusion
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.
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BibTeX
@article{shorog2026symptom,
title = {{Symptom normalization, care-seeking delay, and health-related quality of life in adults with gastroesophageal reflux disease: a cross-sectional study.}},
author = {Eman Shorog and Geetha Kandasamy and Asma M Alshahrani and Leen Alshahrani and Wajd Fahad Al Qahtani and Walaa Abu Rukbah and Shadin Nasreldin Suliman and Bashayr Alsuwayni and Vasudevan Mani and Abdalla Ali Abdalla},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1969209},
url = {https://europepmc.org/article/MED/42952498},
note = {CC BY},
}
RIS
TY - JOUR
TI - Symptom normalization, care-seeking delay, and health-related quality of life in adults with gastroesophageal reflux disease: a cross-sectional study.
AU - Eman Shorog
AU - Geetha Kandasamy
AU - Asma M Alshahrani
AU - Leen Alshahrani
AU - Wajd Fahad Al Qahtani
AU - Walaa Abu Rukbah
AU - Shadin Nasreldin Suliman
AU - Bashayr Alsuwayni
AU - Vasudevan Mani
AU - Abdalla Ali Abdalla
PY - 2026
DA - 2026/10/14
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1969209
UR - https://europepmc.org/article/MED/42952498
AB - Background 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.Methods 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.Results 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 (R² = 0.506; adjusted R² = 0.472). The prespecified Symptom Normalization and Care-Seeking Delay conceptual domain scores were not statistically significantly associated with GERD-HRQoL after adjustment.Conclusion 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.
SN - 2296-858X
ER -