title: Systematic review: the association between symptomatic response to proton pump inhibitors and health-related quality of life in patients with gastro-oesophageal reflux disease.
abstract: BACKGROUND
  Some patients with gastro-oesophageal reflux disease (GERD) experience persistent reflux symptoms on proton pump inhibitor (PPI) therapy. The relationship between persistent reflux symptoms and health-related quality of life (HRQoL) is unclear.
  
  
  OBJECTIVE
  To assess the relationship between persistent reflux symptoms on PPI therapy and HRQoL in patients with GERD.
  
  
  METHODS
  Systematic searches were conducted in PubMed and Embase. Eligible studies had to have used psychometrically evaluated patient reported outcome instruments to assess HRQoL.
  
  
  RESULTS
  Nine studies were included; supplementary data were obtained for four of these. The effect of persistent reflux symptoms despite PPI therapy on physical HRQoL was assessed in seven studies and that on mental HRQoL in five studies. Compared with patients whose reflux symptoms responded to PPIs, those with persistent symptoms had, on average, 8-16% lower scores for physical health (five studies) and 2-12% lower scores for mental health (three studies). Three studies included data on the effect of baseline HRQoL on subsequent symptomatic response to PPI therapy. Patients with persistent symptoms had clinically relevant lower psychological well-being at baseline compared with those whose symptoms responded to PPIs (average score difference: 7%; two studies). High anxiety levels at baseline seemed to be an important aspect of persistent symptoms.
  
  
  CONCLUSIONS
  Persistent reflux symptoms on PPI therapy are associated with reduced physical and mental HRQoL, while reduced mental HRQoL at baseline seems to impair symptomatic response to PPIs. HRQoL may need to be considered alongside reflux symptom frequency and severity when making decisions about disease management.
authors.affiliation: Research Evaluation Unit, Oxford PharmaGenesis Ltd, Oxford, UK.
authors.forename: A
authors.initials: A
authors.lastname: Becher
authors.forename: H
authors.initials: H
authors.lastname: El-Serag
mesh_terms: D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D011788:Quality of Life; D012720:Severity of Illness Index
chemical_list: D054328:Proton Pump Inhibitors