title: Counselling by primary care physicians may help patients with heartburn-predominant uninvestigated dyspepsia.
abstract: OBJECTIVE
  To determine whether strategies to counsel and empower patients with heartburn-predominant dyspepsia could improve health-related quality of life.
  
  
  METHODS
  Using a cluster randomized, parallel group, multicentre design, nine centres were assigned to provide either basic or comprehensive counselling to patients (age range 18 to 50 years) presenting with heartburn-predominant upper gastrointestinal symptoms, who would be considered for drug therapy without further investigation. Patients were treated for four weeks with esomeprazole 40 mg once daily, followed by six months of treatment that was at the physician's discretion. The primary end point was the baseline change in Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire score.
  
  
  RESULTS
  A total of 135 patients from nine centres were included in the intention-to-treat analysis. There was a statistically significant baseline improvement in all domains of the QOLRAD questionnaire in both study arms at four and seven months (P<0.0001). After four months, the overall mean change in QOLRAD score appeared greater in the comprehensive counselling group than in the basic counselling group (1.77 versus 1.47, respectively); however, this difference was not statistically significant (P=0.07). After seven months, the overall mean baseline change in QOLRAD score between the comprehensive and basic counselling groups was not statistically significant (1.69 versus 1.56, respectively; P=0.63).
  
  
  CONCLUSIONS
  A standardized, comprehensive counselling intervention showed a positive initial trend in improving quality of life in patients with heartburn-predominant uninvestigated dyspepsia. Further investigation is needed to confirm the potential benefits of providing patients with comprehensive counselling regarding disease management.
authors.affiliation: Centre hospitalier affilié universitaire de Québec--Hôpital du Saint-Sacrement, Université Laval, 1050 Chemin Sainte-Foy, Quebec City, Quebec. pierre.pare.cha@ssss.gouv.qc.ca
authors.forename: Pierre
authors.initials: P
authors.lastname: Paré
authors.forename: Joanna
authors.initials: J
authors.lastname: Lee
authors.forename: Ian A
authors.initials: IA
authors.lastname: Hawes
mesh_terms: D000293:Adolescent; D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D016000:Cluster Analysis; D003376:Counseling; D037001:Directive Counseling / Q000379:methods*; D004415:Dyspepsia / Q000503:physiopathology / Q000628:therapy*; D064098:Esomeprazole / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006356:Heartburn / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010344:Patient Advocacy; D010353:Patient Education as Topic / Q000379:methods*; D010821:Physicians, Family / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D011320:Primary Health Care / Q000379:methods; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000897:Anti-Ulcer Agents; D064098:Esomeprazole