PGI9 - ACG Guideline and Current Practice in Gastro Esophageal Reflux Disorder: an Outcome Based Study

Abstract

Proton pump inhibitors (PPIs) are the evidence-based therapy for Gastro esophageal Reflux Disorder (GERD). The efficiency of PPIs has driven to its over-utilization and the protracted recipients are targets to its long-term adverse effects. Despite the accessibility of globally acknowledged guidelines, there remains a significant variation between guidelines and the fundamental practice in the treatment of GERD all over the globe, which pose a burden in the quality of patient care. The present study aims to investigate the usefulness of current Hospital Based Practice (HBP) and its adherence to American College of Gastroenterology (ACG) guideline in the management of GERD. This prospective, observational study was conducted among 139 patients who presented with typical and atypical symptoms of GERD to the Outpatient Department of Gastroenterology. The enrolled patients were categorized as ACG group and HBP group based on the therapeutic recommendations made by the gastroenterologists and each group was analyzed majorly in 4 areas (choice of drug, frequency prescribed, duration of therapy and maintenance therapy) for the variances in outcome.The study groups were assessed for their improvement in symptoms using the Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL-15 ) questionnaire and adherence to the prescribed therapy was evaluated using Morisky Medication Adherence Scale (MMAS-4). The study subjects had an average severity score of 66±8.5, 64±10.2 in ACG and HBP group respectively. Adherence to the ACG guidelines in relation to the drug of choice was 90.6%,83.5% in frequency prescribed and 24.46% in duration of therapy, where in HBP it was 9.4%,69.6% and 75.5% respectively. Only 7.19% (n=10) of study population received maintenance therapy. Study showed significant symptoms relief in both the therapy groups (ACG and HBP), although the symptom relief was more significant among the ACG group,hence adopting the more significant changes can benefit the HBP enormously.