Abstract
BackgroundManagement of patients with gastro-oesophageal reflux disease (GORD) can be assisted by information predicting the likely response to proton pump inhibitor (PPI) treatment. The aim was to undertake a study of GORD patients designed to approximate ordinary clinical practice that would identify patient characteristics predicting symptomatic response to pantoprazole treatment.Methods1888 patients with symptoms of GORD were enrolled in a multicentre, multinational, prospective, open study of 8 weeks pantoprazole treatment, 40 mg daily. Response was assessed by using the ReQuest™ questionnaire, by the investigator making conventional clinical enquiry and by asking patients about their satisfaction with symptom control. Factors including pre-treatment oesophagitis, gender, age, body mass index (BMI), Helicobacter pylori status, anxiety and depression, and concurrent IBS symptoms were examined using logistic regression to determine if they were related to response, judged from the ReQuest™-GI score.ResultsPoorer treatment responses were associated with non-erosive reflux disease, female gender, lower BMI, anxiety and concurrent irritable bowel syndrome symptoms before treatment. No association was found with age, Helicobacter pylori status or oesophagitis grade. Some reflux-related symptoms were still present in 14% of patients who declared themselves 'well-satisfied' with their symptom control.ConclusionsSome readily identifiable features help to predict symptomatic responses to a PPI and consequently may help in managing patient expectation. ClinicalTrial.gov identifier: NCT00312806.
Highlights
Management of patients with gastro-oesophageal reflux disease (GORD) can be assisted by information predicting the likely response to proton pump inhibitor (PPI) treatment
GORD studies undertaken on patients with oesophagitis which have used ‘relief of heartburn’ as the principal symptom outcome fail to take into account two important facts widely acknowledged: first, that many GORD patients do not have oesophagitis and second, that the symptom burden experienced by GORD patients is much more complex than heartburn alone[31]
Using an abbreviated form of ReQuestTM, (ReQuest in PracticeTM)[66], scores obtained from the questionnaire were more accurate than the physicians’ conventional clinical enquiry in identifying patients whose symptoms would still be controlled after stepping down from full dose to half dose PPI[67]. In this context at least, prediction based on the systematic assessment of symptom burden is potentially valuable, being more reliable than ordinary clinical judgment. Overall, these results suggest that in the setting of everyday clinical practice, several readily identifiable features can help physicians to foresee the likely success of pantoprazole treatment in controlling symptoms in GORD patients and so to manage patient expectations
Summary
Management of patients with gastro-oesophageal reflux disease (GORD) can be assisted by information predicting the likely response to proton pump inhibitor (PPI) treatment. The overall symptom burden results from the summation of all these symptoms and therapeutic studies that adopt a narrow focus on the classic symptoms, such as heartburn, risk failing to relate to the more complex symptom burden that is the patient’s experience. For this reason, systematic questionnaires (such as ReQuestTM) have been developed to quantify the broader range of symptoms shown to be GORDrelated[8,9].
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