DO GASTROENTEROLOGISTS WITH SELF-REPORTED GERD FOLLOW CURRENT TREATMENT GUIDELINES? A POPULATION-BASED STUDY AT TWO GASTROENTEROLOGY CONFERENCES

Abstract

Purpose: Gastroesophageal reflux disease (GERD) is a common complaint among the general population with a prevalence of approximately 60% in a mailed survey of Olmstead County, Minnesota residents. The currently accepted treatment recommendation is to implement lifestyle modifications as initial treatment for GERD. We conducted a study of practicing gastroenterologists and GI fellows at the 2003 ACG and 2004 DDW conferences to evaluate the prevalence and initial treatment of GERD in this population. Methods: A self-reporting questionnaire was distributed randomly to 224 physicians at ACG and DDW. Physicians were stratified by time in practice (Fellow, Attending <10 years, Attending ≥ 10 years), if they had GERD (yes or no) and by first treatment (lifestyle vs. medical therapy). A subset of 50 physicians was given a more comprehensive questionnaire evaluating symptom frequency and severity. Results: 46% (102 of 224) of conference members interviewed stated they had GERD. The distribution of responders with GERD was approximately 22% fellows, 37% physicians practicing <10 years and 41% physicians practicing ≥10 years. Of these responders, only 1.9% (2 of 102) stated they had tried lifestyle modifications prior to medical therapy. The majority of respondents used standing proton pump inhibitors (PPI) as their initial therapy (39%). The next most common treatment modalities were PRN PPI therapy in 25% and PRN H2 -receptor antagonist therapy in 20%. In the subset of 50 patients evaluating symptom frequency and severity, 30 patients (60%) reported GERD symptoms. Frequency was reported as rare (symptoms <1x per week) in 17 of 30 (57%), occasional (1-3x per week) 7 of 30 (23%) and frequent (>3x per week) 6 of 30 (20%). Severity was graded as mild in 16 of 30 responders (53%). Conclusions: In our study, gastroenterologists and GI fellows reported GERD less often than the general population. Contrary to current treatment recommendations, a very small number of those physicians surveyed used lifestyle modifications as initial GERD therapy even for mild symptoms. There was also a predominance of PPI use in our study despite a high prevalence of mild disease. PRN usage of PPI therapy, though not routinely prescribed to patients, was commonly used by gastroenterologists in our study. Why these discrepancies exist between the recommended guidelines and reported use by gastroenterologists remains unclear.