Primary-care physicians' perceptions and practices on the management of GERD: results of a national survey.
BACKGROUND
Gastroesophageal reflux disease (GERD) is frequently managed by primary-care physicians (PCPs) although little is known about their current practices and management patterns.


METHODS
We administered a questionnaire-based survey to PCPs attending sponsored educational conferences on GERD. Questionnaires were completed anonymously before the conferences and asked about prescribing patterns, indications for surgical referral, and issues concerning Barrett's esophagus and H. pylori infection.


RESULTS
A total of 1046 completed questionnaires (97% acceptance rate) were received. Most PCPs prescribed a proton pump inhibitor (PPI) for GERD without prior authorization and without first using an H2-receptor antagonist (H2RA). Many gave an H2RA with once-daily PPI treatment for patients with nocturnal heartburn. Most referrals for anti-reflux surgery were for inadequate response to medical treatment, although PCPs usually first sought gastroenterological consultation. There was a widespread acceptance of screening GERD patients for Barrett's esophagus. There was general confusion about any relationship between H. pylori infection and GERD; 80% of PCPs tested for the infection in at least some patients who only had symptoms of GERD.


CONCLUSIONS
Our survey has identified a number of areas of controversy and confusion related to the management of GERD. We hope that our findings can assist in the development of educational materials on GERD for PCPs.
Chey
William D
WD
University of Michigan Health System, Ann Arbor, Michigan 49109-0362, USA.
Inadomi
John M
JM
Booher
Anna M
AM
Sharma
Virender K
VK
Fendrick
A Mark
AM
Howden
Colin W
CW
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D004944:Esophagoplasty; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D019538:Health Care Surveys; D006356:Heartburn / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010821:Physicians, Family / Q000592:standards / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D054328:Proton Pump Inhibitors; D011787:Quality of Health Care; D011788:Quality of Life; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors