Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Jun 22, 2025; 16(2): 107994
Published online Jun 22, 2025. doi: 10.4291/wjgp.v16.i2.107994
Development and validation of a risk prediction model for gastroesophageal reflux disease: Gastroesophageal Reflux Disease Risk Scoring System
Shanmathi Subramanian, Umashri Sundararaju, Hamrish Kumar Rajakumar, Varsha Coimbatore Sathyabal, Arun Murugan, Pavithra Gnanavel, Kasinathan Sathishkumar
Shanmathi Subramanian, Umashri Sundararaju, Hamrish Kumar Rajakumar, Varsha Coimbatore Sathyabal, Department of General Surgery, Government Medical College, Omandurar Government Estate, Chennai 600002, Tamil Nādu, India
Arun Murugan, Pavithra Gnanavel, Kasinathan Sathishkumar, Department of Community Medicine, Government Medical College, Omandurar Government Estate, Chennai 600002, Tamil Nādu, India
Co-first authors: Shanmathi Subramanian and Umashri Sundararaju.
Author contributions: Subramanian S was involved in conceptualization, formal analysis, writing the first draft, literature search, study design, and data collection; Sundararaju U contributed to conceptualization, formal analysis, methodology, writing the first draft, literature search, study design, and data collection; Rajakumar HK contributed to conceptualization, data curation, formal analysis, methodology, writing the first draft, data collection, analysis, and interpretation; Sathyabal VC participated in conceptualization, formal analysis, writing the first draft, literature search, and study design; Murugan A provided supervision, data analysis, and reviewed and edited the manuscript; Gnanavel P and Sathishkumar K were responsible for data analysis and reviewing and editing the manuscript; all authors had access to the data, contributed to the manuscript, and approved the final version for publication.
Institutional review board statement: This study was approved by the Institutional Ethics Committee of Government Medical College, Omandurar, Government Estate. All procedures performed in studies involving human patients were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments.
Clinical trial registration statement: This study is not a clinical trial as defined by the International Committee of Medical Journal Editors and the World Health Organization. This study was not required to be registered as a clinical trial. The research received approval from the local Institutional Ethics Committee.
Informed consent statement: Written informed consent for participation and publication has been obtained from the study participants.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The data utilized in this research will be accessible upon request from Rajakumar HK but will not be publicly accessible to safeguard the confidentiality and privacy of the patients who participated. Requests for data access must specify the purpose for which the data will be utilized. In cases of data reuse, a proposal outlining the purpose, the intended usage of the data, and a letter from the department head or the institution's leadership will be mandatory. Additionally, any subsequent data generation should be communicated to the Rajakumar HK.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hamrish Kumar Rajakumar, Senior Researcher, Department of General Surgery, Government Medical College, Omandurar Government Estate, Wallajah Road, Triplicane, Chennai 600002, Tamil Nādu, India. hamrishkumar2003@gmail.com
Received: April 2, 2025
Revised: April 17, 2025
Accepted: May 18, 2025
Published online: June 22, 2025
Processing time: 78 Days and 12.3 Hours
Abstract
BACKGROUND

The rising global prevalence of gastroesophageal reflux disease (GERD) has been closely linked to lifestyle changes driven by globalization. GERD imposes a substantial public health burden, affecting quality of life and leading to potential complications. Early intervention through lifestyle modification can prevent disease onset; however, there is a lack of effective risk prediction models that emphasize primary prevention.

AIM

To develop and validate a GERD Risk Scoring System (GRSS) aimed at identifying high-risk individuals and promoting primary prevention strategies.

METHODS

A 45-item questionnaire encompassing major lifestyle and demographic risk factors was developed and validated. It was administered to healthy controls and GERD patients. Two regression models—one using continuous variables and another using categorized variables—were used to develop a computational prediction equation and a clinically applicable scoring scale. An independent validation cohort of 355 participants was used to assess model performance in terms of discrimination (C-index), calibration, sensitivity, specificity, internal consistency (Cronbach's alpha), and test-retest reliability (intraclass correlation coefficient, Bland–Altman analysis).

RESULTS

Significant associations were observed between GERD and key lifestyle factors. The derived GRSS equation and scoring scale demonstrated strong discriminative ability, with high sensitivity and specificity. The scoring system exhibited excellent internal consistency (Cronbach’s alpha) and strong test-retest reliability. The C-index indicated excellent predictive accuracy in both derivation and validation cohorts.

CONCLUSION

GRSS offers a novel and validated approach to GERD risk prediction, combining a robust equation for digital applications and a practical scale for clinical use. Its ability to accurately identify at-risk individuals supports a paradigm shift toward primary prevention, underscoring its significance in addressing the growing burden of GERD at the population level.

Keywords: Gastroesophageal reflux disease; Risk prediction; Lifestyle factors; Gastroesophageal Reflux Disease Risk Scoring System score; Logistic regression; Validation study; Questionnaire; Primary prevention; Early intervention

Core Tip: There has been a steady rise in the prevalence of gastroesophageal reflux disease (GERD) due to globalization. This study introduces the GERD Risk Scoring System (GRSS), a novel primary prevention tool for assessing GERD susceptibility based on key lifestyle and demographic factors. Using logistic lasso regression, the model demonstrated high predictive accuracy, with strong internal consistency and reliability. GRSS provides both a computational risk equation and a practical scoring scale for clinical use. By enabling early identification of at-risk individuals, GRSS facilitates targeted lifestyle modifications, supporting primary prevention and reducing the long-term burden of GERD-related complications.