title: Maintenance treatment for GERD: residual symptoms are associated with psychological distress.
abstract: OBJECTIVE
  The aim of this study was to explore determinants of residual reflux symptoms among patients with gastroesophageal reflux disease (GERD) despite maintenance treatment with acid suppressive medication (ASM).
  
  
  METHODS
  Primary care GERD patients on chronic ASM were classified as symptom-free (55%) or symptomatic (45%) according to the impact of their residual reflux symptoms (QolRad). They were compared with respect to lifestyle (BMI, alcohol, smoking, physical exercise), compliance (daily ASM dosage), disease history, psychological factors (SCL-90) and quality of life (SF-36).
  
  
  RESULTS
  None of the investigated lifestyle factors, nor dosage and disease history were related to residual symptoms. However, symptomatic patients differed from patients with relief on all psychological and quality of life dimensions. In a multiple logistic regression model somatization, hostility, mental health, body pain, as well as gender were independently associated with residual symptoms; the derived ROC curve had an AUC of 0.78.
  
  
  CONCLUSIONS
  The majority of GERD patients is symptom-free on chronic ASM; they display a healthy psychological state and high quality of life. Residual symptoms however, are associated with psychological distress and lower quality of life. Recognition of this subgroup might hold the key to improving long-term management of gastroesophageal reflux.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. a.w.vandervelden@umcutrecht.nl
authors.forename: A W
authors.initials: AW
authors.lastname: van der Velden
authors.forename: N J
authors.initials: NJ
authors.lastname: de Wit
authors.forename: A O
authors.initials: AO
authors.lastname: Quartero
authors.forename: D E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: M E
authors.initials: ME
authors.lastname: Numans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000523:psychology*; D006305:Health Status Indicators; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D011788:Quality of Life; D013315:Stress, Psychological / Q000453:epidemiology*
chemical_list: D054328:Proton Pump Inhibitors