Typical errors in therapy of gastroesophageal reflux disease

Abstract

To analyze compliance of doctors with the clinical guidelines for the management of patients with gastroesophageal reflux disease (GERD) under outpatient clinic conditions. An anonymous questionnaire study involving 104 general practitioners was undertaken. The questionnaires included items concerning lifestyle modifications, the use of proton pump inhibitors (PPI), dosage and time of their administration, combined therapy and endoscopic control. The analysis of the filled questionnaires demonstrated that 15,6% of the doctors always discuss the necessity changing lifestyle with GERD patients, 75% of the doctors discuss it but occasionally, and 9,4% never hold such discussions. 56,7% of the doctors begin treatment from double doses of proton pump inhibitors regardless of the endoscopic stage of esophagus damage. The mode of PPI administration is at variance with that recommended by the instruction in 61,5% of the cases. The basic course of erosive esophagitis treatment lasts 4, 2, and 8 weeks in 45,2%, 9,6%, and 45,2% of the cases. Treatment of GERD starts from combined therapy in 14,4% of the cases. Monotherapy with PPI is inefficient in 85,6% of the cases. Endoscopic control of erosive esophagitis is practiced by 51,9% of the doctors, 48,1% of the respondents recommend this diagnostic procedure only in the absence of clinical effect. Our analysis revealed typical mistakes in the treatment of patients with GERD, demonstrated the importance of expert control and support of training physicians, and introduction of modern quality standards into the practical management of patients with this pathology.