[Symptom profile in gastroesophageal reflux disease in untreated patients and those with persistent symptoms despite treatment].
OBJECTIVE
1. To analyze the symptom profile of gastroesophageal reflux disease (GERD) with typical clinical manifestations (heartburn and/or regurgitation); 2. to compare untreated patients with those with persistent symptoms despite treatment; 3. to evaluate severity according to physicians' and patients' opinions; and 4. to determine the diagnostic and therapeutic approaches used.


METHODS
We performed a prospective, observational, cross-sectional study under conditions of standard clinical practice.


RESULTS
A total of 2356 patients were included. Dyspeptic symptoms were highly frequent (close to 90% in both groups) and supraesophageal symptoms were also common (50-60%). Patients with persistent symptoms despite treatment were older, and had more supraesophageal symptoms; in addition, the typical supraesophageal and dyspeptic symptoms of GERD were more severe in these patients. Severity evaluations by patients and doctors were concordant but patients considered severity to be greater. Older age was a risk factor for supraesophageal symptoms, female gender for dyspeptic symptoms and body mass index for greater severity of GERD symptoms. Endoscopy was requested in about 60% of the patients. Diet counseling was advised in most patients and postural recommendations were made in more than half. Proton pump inhibitors were prescribed in almost all patients, and were associated with prokinetics and/or antacids in many patients.


CONCLUSIONS
Dyspeptic symptoms should not be considered as independent of GERD, and typical and atypical symptoms are associated in 50% of patients. Gastroenterologists follow clinical practice guidelines fairly closely but diagnostic procedures seem to be overindicated.
Servicio de Medicina Digestiva, Hospital Universitario La Fe, Valencia, España. jponceg@medynet.com
Julio
J
Ponce
Fermín
F
Mearin
Marta
M
Ponce
Agustín
A
Balboa
Javier
J
Zapardiel
D000328:Adult; D000368:Aged; D000863:Antacids / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology*; D003430:Cross-Sectional Studies; D004351:Drug Resistance; D004415:Dyspepsia / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications; D019338:Polypharmacy; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D017211:Treatment Failure
D000863:Antacids; D054328:Proton Pump Inhibitors