The Changing Impact of Gastroesophageal Reflux Disease in Clinical Practice: An Updated Study

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Objectives: (1) Understand evolving national trends in diagnosis and management of reflux disease. (2) Be able to analyze these by provider specialty. Methods: National Ambulatory Medical Care Survey (NAMCS) data for time periods 1998-2001, 2002-2005, and 2006-2009 were reviewed for number of visits, provider type, and prescriptions provided. Results: Addition of 2 more 4-year periods to previously reported data demonstrates increasing ambulatory visits for reflux across all races, sexes, and age groups. In 2006-2009, there were 15,750,000 visits for reflux, representing 6.9 visits per 100 people on a population basis. Overall visits increased across each sequential time period for internal medicine, family, and gastroenterology physicians. Among otolaryngologists, reflux visits increased from 1998-2001 to 2002-2005 but then decreased in 2006-2009; percentage of reflux visits to otolaryngologists fell from 4.4% in 2002-2005 to 2.9% in 2006-2009. Approximately two-thirds of reflux visits were among internal medicine and family practice providers. Among the 3 study periods, number of reflux prescriptions increased 233% with continuing trends toward increased proton pump inhibitor and reduced H2 antagonist use. Conclusions: Number of ambulatory visits for reflux continues to increase over time, across all demographic subgroups studied. Otolaryngologists are the only specialty who saw a decrease in overall reflux visits from 2002-2005 through 2006-2009; this may reflect real change in practice patterns, change in coding strategies or uncertainty in firmly establishing a reflux diagnosis. Understanding trends in this increasingly prevalent disease may focus attention on more precise diagnosis and improved treatment.