Impact of PPIs on patient focused symptomatology in GERD.
About half of patients with gastroesophageal reflux disease (GERD) have a normal endoscopy, so symptom assessment is the only appropriate outcome measure for these persons. Symptom assessment is also of great importance in persons with erosive esophagitis. There is currently no fully validated questionnaire to compare symptom response to treatment of patients with GERD. The aim of this review is to consider ReQuest() assessment tool to evaluate esophageal, supra-esophageal, and infra-esophageal symptoms, as well as any modification of the patient's quality of life. The ReQuest() may be combined with the Los Angeles classification of esophagitis (LA A-D), to include the normal endoscopic finding in normal endoscopy reflux disease. The ReQuest() score declines rapidly towards normal with patient treatment with a proton pump inhibitor. A proportion of patients need more than the usual 8 weeks of therapy. For example, in GERD patients with Los Angeles B-D, the ReQuest() score falls more with pantoprazole 40 mg than with esomoprazole 40 mg after 12 weeks of therapy. Now that the simplified ReQuest in Practice() is available, this validated brief questionnaire has potential as an instrument for use in GERD patients seen in everyday clinical practice.
Thomson
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Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. alan.thomson@ualberta.ca