title: Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists.
abstract: OBJECTIVE
  To investigate usefulness of adherence to gastro-esophageal reflux disease (GERD) guideline established by the Spanish Association of Gastroenterology.
  
  
  METHODS
  Prospective, observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily practice. Patients (aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD (heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms, such as dyspeptic symptoms and/or supraesophageal symptoms. Diagnostic and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease specialists.
  
  
  RESULTS
  Endoscopy was indicated in 123 (41%) patients: 50 with alarm symptoms, 32 with age > 50 years without alarm symptom. Seventy-two patients (58.5%) had esophagitis (grade A, 23, grade B, 28, grade C, 18, grade D, 3). In the presence of alarm symptoms, endoscopy was indicated consistently with recommendations in 98% of cases. However, in the absence of alarm symptoms, endoscopy was indicated in 33% of patients > 50 years (not recommended by the guideline). Adherence for proton pump inhibitors (PPIs) therapy was 80%, but doses prescribed were lower (half) in 5% of cases and higher (double) in 15%. Adherence regarding duration of PPI therapy was 69%; duration was shorter than recommended in 1% (4 wk in esophagitis grades C-D) or longer in 30% (8 wk in esophagitis grades A-B or in patients without endoscopy). Treatment response was higher when PPI doses were consistent with guidelines, although differences were not significant (95% vs 85%).
  
  
  CONCLUSIONS
  GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms; PPIs were prescribed at higher doses and longer duration.
authors.affiliation: Service of Gastroenterology, Centro Medico Teknon, V/Vilana 12, Barcelona, Spain. fmearinm@meditex.es
authors.forename: Fermín
authors.initials: F
authors.lastname: Mearin
authors.forename: Julio
authors.initials: J
authors.lastname: Ponce
authors.forename: Marta
authors.initials: M
authors.lastname: Ponce
authors.forename: Agustín
authors.initials: A
authors.lastname: Balboa
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González
authors.forename: Javier
authors.initials: J
authors.lastname: Zapardiel
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D016099:Endoscopy, Gastrointestinal / Q000592:standards*; D004941:Esophagitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005762:Gastroenterology / Q000592:standards*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors