Gastroesophageal Reflux Disease Impact Scale Research Articles

Management of gastroesophageal reflux disease in primary care settings in Spain: SYMPATHY I study

Our study was designed to assess the symptom loads, treatment strategies, and impact on daily life of patients with gastroesophageal reflux disease (GERD) symptoms who consulted primary care (PC) health care providers in Spain. This was a multicenter, observational, cross-sectional study in a sample of 5735 consecutive patients visiting PC clinics with GERD symptoms. Participating primary care physicians (PCPs) collected clinical data by using a questionnaire, and completed a survey on their perceptions of diagnostic and therapeutic approaches to GERD. Patients self-completed the GERD Impact Scale during the study visit. In the week before visiting the PC clinic, typical GERD symptoms were present in a majority of patients (89.6% heartburn and 81.6% regurgitation), but extraesophageal symptoms were also frequent (55.6% reflux-related sleep disturbances, 45.7% noncardiac chest pain, 30.8% chronic cough, and 24.7% hoarseness), these being more prevalent in the patients diagnosed earlier. Although primary care physicians considered that 55.9% of the patients could be diagnosed on the basis of symptoms without further investigation, in their practice only one-third of new diagnoses of GERD and 71.1% of those already diagnosed were symptom-managed. Upon arrival at the clinic, patients with GERD symptoms were taking the following medications: 28.1% (47.8% in the case of those already diagnosed) proton pump inhibitors (PPIs), 16.6% antacids, 6.1% H2 antagonists, and 4.5% prokinetics. Most patients (90.2%) were treated with PPIs after the study visit. The evaluation of agreement between physicians and patients on the severity of GERD resulted in a kappa index of 0.19. There is a high occurrence of typical and extraesophageal symptoms in patients in Spain complaining of GERD symptoms in PC settings. Two-thirds of new GERD patients were referred for further investigation. PPIs were the treatment prescribed in almost all cases. The degree of agreement between physicians and patients about the severity of the symptoms was limited.

Impact of gastroesophageal reflux disease on patients' daily lives: a European observational study in the primary care setting

BackgroundThe impact of gastroesophageal reflux disease (GERD) on the daily lives of patients managed in primary care is not well known. We report the burden of GERD in a large population of patients managed in primary care, in terms of symptoms and impact on patients' daily lives.MethodsRANGE (Retrospective ANalysis of GERD) was an observational study that was conducted at 134 primary care sites across six European countries. All adult subjects who had consulted their primary care physician (PCP) during a 4-month identification period were screened retrospectively and those consulting at least once for GERD-related reasons were identified. From this population, a random sample of patients was selected to enter the study and attended a follow-up appointment, during which the Reflux Disease Questionnaire (RDQ), the GERD Impact Scale (GIS) and an extra-esophageal symptoms questionnaire were self-administered. Based on medical records, data were collected on demographics, history of GERD, its diagnostic work-up and therapy.ResultsOver the 4-month identification period, 373,610 subjects consulted their PCP and 12,815 (3.4%) did so for GERD-related reasons. From 2678 patients interviewed (approximately 75% of whom reported taking medication for GERD symptoms), symptom recurrence following a period of remission was the most common reason for consultation (35%). At the follow-up visit, with regard to RDQ items (score range 0–5, where high score = worse status), mean Heartburn dimension scores ranged from 0.8 (Sweden) to 1.2 (UK) and mean Regurgitation dimension scores ranged from 1.0 (Norway) to 1.4 (Germany). Mean overall GIS scores (range 1–4, where low score = worse status) ranged from 3.3 (Germany) to 3.5 (Spain). With regard to extra-esophageal symptoms, sleep disturbance was common in all countries in terms of both frequency and intensity.ConclusionIn this large European observational study, GERD was associated with a substantial impact on the daily lives of affected individuals managed in the primary care setting.

T1079 Health-Related Quality of Life in Primary Care Patients with GERD, Identified with Gastro-Esophageal Reflux Disease Questionnaire (GERD-Q)

enablement and patient satisfaction. Methods: Patients under treatment for GORD by 26 family practitioners in 5 primary care centres in the UK who had consented to take part in a quality improvement project completed survey instruments including the Gastro-oesophageal reflux disease Impact Scale (GIS), QOLRAD, EQ5D, HADS, PEI (Patient Enablement Instrument) and GPAQ (General Practice Assessment of Quality consultation subscale). Results: We studied 327 patients, of whom 54% were women, mean age 63.7 years (range 23-93), with a mean duration of GORD of 6.0 years (range 0.2-70). 62% of patients had contacted their primary care physician for GORD during the previous 12 months, mean consultation rate 2.8 (range 1-40). 14% consulted a gastroenterologist (mean 1.7 consultations; range 1-6) and 17% reported having an endoscopy. The mean GIS score was 15.3 (range 933), indicating significant persistence of symptoms; with around 25% reporting persistent heartburn, regurgitation, abdominal pain, interference with sleeping and symptoms affecting eating. Similarly, 26% said that these symptoms affected their performance in the daytime. The mean QOLRAD score was 150.5 (range 49-178), and the mean EQ5D score was 72.3 (range 10-100). Persistent symptoms were correlated with anxiety (r=0.478, p<0.0005), and depression (r=0.471, p<0.0005), and were significantly inversely correlated with satisfaction with GP consultations (r=-0.301, p<0.0005). Quality of life was inversely related to persisting anxiety (r=-0.516, p<0.0005), depression (r=-0.546, p<0.0005) and reduced satisfaction with GP consultations (r=0.255, p<0.0005). There was no association between symptom severity or QOL and patient enablement Conclusion: In a representative population of patients with GORD managed in primary care in the UK around 25% report persisting symptoms and substantial impacts on their quality of life. These problems appear to be in part related to existing anxiety and depression and to relatively low scores on patient enablement and patient satisfaction instruments and offer a range of opportunities to improve management.

Prevalence of, and factors associated with, gastroesophageal reflux disease: a population-based study in Shanghai, China

The prevalence of gastroesophageal reflux disease (GERD) in China is lower than that in the Western countries, but appears to be increasing. The aim of this pilot study was to evaluate the prevalence of GERD in Shanghai, China, and to explore which population characteristics where associated with GERD. A sample of 1200 adult inhabitants of Shanghai, selected using randomized, stratified, multi-stage sampling, completed Mandarin translations of the Reflux Disease Questionnaire and GERD Impact Scale. Potential risk factors for GERD were examined by nested case-control analysis, using Cochran-Armitage trend testing and logistic regression analysis. The response rate was 86.2%; 919 responses were suitable for analysis. The prevalence of GERD, defined as heartburn and/or regurgitation of any frequency during the previous week, was 6.2% in Shanghai. Obesity and urban dwelling were associated with GERD (odds ratio 3.4, 95% confidence interval 1.3-9.3; and odds ratio 3.6, 95% confidence interval 1.2-10.4, respectively). The prevalence of GERD in Shanghai agreed with previous Chinese studies. GERD in Shanghai was associated with obesity and residency in an urban environment.

The effectiveness of esomeprazole 40 mg in patients with persistent symptoms of gastro-oesophageal reflux disease following treatment with a full dose proton pump inhibitor

Background:Some patients with gastro-oesophageal reflux disease (GORD) remain symptomatic despite proton pump inhibitor (PPI) treatment. There is a need to determine the most appropriate management of these patients.Aims:To assess the effectiveness of esomeprazole 40 mg in GORD symptoms persisting in patients receiving a full daily dose PPI.Methods:In this multi-centre open label study patients who had received full daily dose PPI for 8 weeks, but were still experiencing persistent GORD symptoms, were treated with esomeprazole 40 mg for 8 weeks (n = 99). The primary outcome variable was the change in the frequency of heartburn. Patient-reported outcomes were also assessed using the Reflux Disease Questionnaire (RDQ) and the GORD Impact Scale (GIS).Results:The mean frequency of heartburn was reduced by 78% from 4.4 days a week to 1 day a week at the end of the 8-week treatment period (p < 0.0001). Other GORD symptoms were also significantly reduced following of treatment with esomeprazole (all p < 0.0001). All RDQ dimensions and the level of symptom control as measured by the GIS also showed significant improvement at 8 weeks.Conclusions:In patients with persistent GORD symptoms despite full dose daily PPI therapy, esomeprazole 40 mg significantly improved the frequency and severity of all GORD symptoms.

Burden of gastroesophageal reflux disease in Shanghai, China

Data on the impact of gastroesophageal reflux disease (GERD) on health-related quality of life (HRQL) in Asian countries are scarce. This study evaluated the impact of GERD on HRQL in Shanghai, China. One thousand two hundred adult inhabitants of Shanghai, selected using randomized cluster sampling. Participants completed Mandarin versions of the Reflux Disease Questionnaire (RDQ), GERD impact scale, quality of life in reflux and dyspepsia (QOLRAD) questionnaire and short-form-36 (SF-36). GERD was defined as heartburn and/or regurgitation of any frequency during the 1-week recall period of the RDQ. A clinically meaningful impairment of HRQL was defined as a statistically significant decrease of >or=0.5 points in a QOLRAD dimension or >or=5 points in an SF-36 dimension. Overall, 1034 subjects completed the survey (86.2% response rate); 919 responses were suitable for analysis. The prevalence of GERD was 6.2%. GERD was associated with meaningfully impaired HRQL in the QOLRAD dimensions of vitality, eating/drinking and emotional well-being, but not sleep or physical/social functioning, and in all SF-36 dimensions except social functioning. Respondents with GERD experienced eating and drinking problems (47%), sleep impairment (32%) and reduced work productivity (32%). GERD has a clinically meaningful impact on HRQL in Shanghai, China.

Accounting for the effect of GERD symptoms on patients’ health-related quality of life: supporting optimal disease management by primary care physicians

AimTo review, from a primary care physician (PCP) perspective, the use of patient-reported outcome (PRO) instruments for assessment of gastro-oesophageal reflux disease (GERD) symptoms, their impact on health-related quality of life (HRQL) and the effectiveness of therapy.ResultsWhile generic and disease-specific PRO instruments have been used in the assessment of GERD, the latter can be considered to be more appropriate as they focus only on problems relevant to the disease in question (and therefore tend to be more responsive to change). Such instruments include the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire and the Gastrointestinal Symptom Rating Scale and the Reflux Disease Questionnaire (RDQ). Their use indicates that GERD symptoms are troublesome and significantly reduce patients’ HRQL, and that effective treatment of GERD improves HRQL. The GERD Impact Scale (GIS) questionnaire, primarily developed for use within primary care, can also help to determine the impact of symptoms on patients’ everyday lives and, in turn, the benefit of appropriately targeted therapy. Notably, these PRO instruments were developed from focus groups of GERD patients, and only aspects rated of highest importance are used in the final instruments. Consequently, PCPs can feel confident that these questionnaires encompass the most relevant points that they are likely to ask in terms of how symptoms affect patients’ everyday lives.ConclusionsPrimary care physicians are encouraged to make wider use of PRO instruments within routine practice to improve communication with their GERD patients that, in turn, could lead to improved clinical outcomes and greater patient satisfaction.Review CriteriaWe conducted a review of validated patient-reported outcome (PRO) instruments used in gastro-oesophageal reflux disease (GERD), based on the authors’ expertise in the field and a supplementary MEDLINE search with the terms ‘health-related quality of life’, ‘quality of life questionnaire’, ‘patient-reported outcomes’, ‘patient satisfaction’ and ‘gastro-oesophageal reflux disease’.We reviewed papers reporting health-related quality of life (HRQL) data in patients with GERD, including the effect of GERD on HRQL, treatment efficacy and HRQL, patient satisfaction and physician-patient agreement, to help primary care physicians to incorporate PRO instruments into their day-to-day management of patients with GERD.Message for the ClinicAn evidence-based review shows that PRO instruments can accurately assess the nature of GERD symptoms, their impact on HRQL and the efficacy of treatment.Primary care physicians are encouraged to make wider use of PRO instruments as part of their management of patients with GERD, given that such questionnaires can facilitate patient communication and help physicians understand and satisfy the therapeutic needs of their patients.Among validated PRO instruments, the GERD Impact Scale represents a practical tool that is easy for primary care physicians to incorporate into their everyday practice.

The Gastro‐oesophageal Reflux Disease Impact Scale: a patient management tool for primary care

Symptoms of gastro-oesophageal reflux disease have a substantial impact on patients' everyday lives. To develop and test a short questionnaire to aid patient-doctor communication. The Gastro-oesophageal Reflux Disease Impact Scale was developed from a systematic literature review, focus groups of patients and primary care physicians, and patient cognitive interviews. A psychometric validation study was conducted based on two consultations in new (n = 100) or chronic (n = 105) gastro-oesophageal reflux disease patients. The Gastro-oesophageal Reflux Disease Impact Scale demonstrated internal consistency (Cronbach's alpha ranged from 0.68 to 0.82), reproducibility (intraclass correlation coefficient in stable patients ranged from 0.61 to 0.72) and construct validity (Spearman correlations with Quality of Life in Reflux and Dyspepsia instrument and Reflux Disease Questionnaire: 0.5-0.8 in both patient groups). Effect sizes in new and chronic gastro-oesophageal reflux disease patients ranged from 0.9 to 1.5 and 0.32 to 0.42, respectively. Doctors reported altering their treatment decision based on information provided by the Gastro-oesophageal Reflux Disease Impact Scale in 35% of patients, and 77% of doctors found it to be useful. The Gastro-oesophageal Reflux Disease Impact Scale demonstrated good psychometric properties in newly diagnosed gastro-oesophageal reflux disease patients and those already receiving treatment. This simple communication tool is a useful aid for managing primary care patients with gastro-oesophageal reflux disease.