title: Empirical treatment for the management of patients presenting with uninvestigated reflux symptoms: a prospective study in an Asian primary care population.
abstract: BACKGROUND
  Data on Asian patients who present with reflux symptoms to their primary care physicians are limited.
  
  
  OBJECTIVE
  To determine whether empirical therapy without endoscopy is appropriate for patients who present to their primary care physicians with uninvestigated reflux symptoms without alarm symptoms.
  
  
  METHODS
  Forty-seven patients presenting with uninvestigated, dominant reflux symptoms but without alarm features to their primary care physicians underwent endoscopy within 2 weeks of referral. Their endoscopic findings were compared with those of 162 primary care patients presenting with uninvestigated dominant dyspepsia. All patients, except those with ulcers, were treated with esomeprazole 20 mg b.d. for 2 weeks. Their treatment response was assessed at 2 weeks using a symptom score.
  
  
  RESULTS
  Among patients with dominant reflux symptoms, 14 (30%) had erosive oesophagitis. No other clinically significant endoscopic findings were detected among them. In contrast, erosive oesophagitis and peptic ulcer were found in 13 (8%, P < 0.001 vs. reflux group), and 12 (7%, P = 0.06 vs. reflux group), respectively, of patients with dominant dyspepsia. Thirty-seven of forty-five (82%) of those with dominant reflux symptoms and 109 of 139 (78%; P = N.S. vs. reflux group) of those with dominant dyspepsia reported > or = 50% resolution of symptoms after esomeprazole treatment.
  
  
  CONCLUSIONS
  Empirical proton pump inhibitor without endoscopy is reasonable for uninvestigated patients who present to primary care physicians with dominant reflux symptoms.
authors.affiliation: Department of Medicine, National University Hospital, Singapore. mdchoky@nus.edu.sg
authors.forename: K Y
authors.initials: KY
authors.lastname: Ho
authors.forename: K A
authors.initials: KA
authors.lastname: Gwee
authors.forename: C J
authors.initials: CJ
authors.lastname: Khor
authors.forename: D S
authors.initials: DS
authors.lastname: Selamat
authors.forename: C T
authors.initials: CT
authors.lastname: Wai
authors.forename: K G
authors.initials: KG
authors.lastname: Yeoh
mesh_terms: D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D064098:Esomeprazole / Q000627:therapeutic use*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000897:Anti-Ulcer Agents; D064098:Esomeprazole