PGI20 Diagnosis and Treatment Patterns of Gastroesophageal Reflux Disease in China: A Retrospective Real-World Study

Abstract

This study sought to assess real-world diagnostic practices, treatment patterns, treatment effectiveness, and cost of gastroesophageal reflux disease (GERD) in China, which are currently limited. Retrospective data of patients with a GERD diagnosis were pooled from Electronic Medical Records across 11 hospitals (10 provinces) in China (January 2015 to December 2017). Primary outcomes included GERD patient characteristics, trends in hospital department visits, symptom types, and treatment patterns. Secondary outcomes included the proportion and grade of erosive esophagitis (EE), mucosal healing rate, healthcare resource utilization and associated costs. Descriptive analyses and Wilcoxon rank-sum test are performed. 71,904 patients (48.1% male; mean (SD) age, 49.28 years) with a GERD diagnosis were identified, of which 65.6% were diagnosed and treated in a gastrointestinal department. GERD subtypes identified were non-erosive reflux disease (NERD;82.8%), EE (15.5%), and Barrett’s esophagitis (1.7%). Los Angeles A-B comprised the majority of EE (93.8%, n=1396/1488). Typical, atypical, and extraesophageal symptoms occurred in 62.7%, 48.3% and 12.1% of GERD patients, respectively. Approximately, 16.4% of GERD patients underwent endoscopic examination. Proton pump inhibitors (PPIs) were the most prescribed medication for GERD (95.6%), followed by gastroprokinetic agents (57.3%). Furthermore, 75.8% of PPIs were prescribed in combination regimens (74.1% with gastroprokinetic agents, 6.5% with mucosal protectants and 2.9% with H2 antagonists). The EE mucosal healing rate after standard treatment regimens was 50% in EE patients who has two endoscopic results within 12 weeks. Overall, median cost per outpatient visit was significantly higher for gastrointestinal vs. non-gastrointestinal departments (¥424.6 vs. ¥387.82; p<0.01). NERD was the most common subtype in GERD patients in China. Low endoscopy (to diagnose GERD) and mucosal healing rates in EE were observed. PPI combination treatment was the most prescribed regimen, suggesting inadequate symptom control with PPI monotherapy.