Survey of primary care physicians' approach to gastroesophageal reflux disease in elderly patients.
BACKGROUND
Although gastroesophageal reflux disease (GERD) is a common condition, little is known regarding physicians' approach to the diagnosis and management of GERD in elderly patients.


METHODS
We surveyed by facsimile a random sample of 14,000 practicing primary care physicians throughout the United States. Physicians were questioned using a case-based format about the approach to a symptomatic patient with GERD including the use of empiric therapy, the role of diagnostic testing, and the drugs of choice to treat GERD.


RESULTS
A total of 2241 surveys (16%) was returned and tabulated. Most respondents were either internists (37%) or family practice physicians (56%) in solo or group practice, and 74% had been in practice for 11 or more years. There were 1980 (90%) respondents who evaluated more than 6 patients per week with GERD. Empiric therapy was commonly recommended for the symptomatic patient, most often in a step-up approach beginning with H(2)-receptor blockers. Diagnostic testing, usually endoscopy, was recommended appropriately in patients with alarm symptoms. Proton-pump inhibitors were most often recommended for patients failing to respond to over-the-counter H(2)-receptor blockers and for those with endoscopic esophagitis; the use of cisapride in combination with H(2)-receptor blockers was also commonly recommended in these scenarios.


CONCLUSIONS
The management of symptomatic GERD in elderly patients appears similar to the management of GERD in other patients. Empiric therapy was frequently recommended in a step-up approach, and diagnostic testing was appropriate. Combination therapy with cisapride and an acid-reducing agent was commonly recommended.
Wilcox
C M
CM
Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA. mel_wilcox@gihep.uab.edu
Heudebert
G
G
Klapow
J
J
Shewchuk
R
R
Casebeer
L
L
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D016145:Endoscopy, Digestive System; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D011379:Prognosis; D017678:Sex Distribution; D014481:United States
D000897:Anti-Ulcer Agents