title: [Application of the recommendations of the conference of consensus in front of symptoms ENT, respiratory or thoracic pains considered as due to a gastroesophageal reflux disease].
abstract: OBJECTIVE
  The primary objectives of this observatory were: (1) to assess the prevalence of extradigestive symptoms (EDS) (asthma, pharyngeal pain, chronic hoarseness, nocturnal breathlessness, chronic or nocturnal cough, non-cardiac chest pain) which are suspected of being associated with gastro-oesophageal reflux (GERD) in a population consulting in general practice; (2) to compare the diagnostic and therapeutic approach adopted initially and at follow-up to the recommendations of the French-Belgian Consensus Conference on adult GERD (1999).
  
  
  METHODS
  The survey was conducted among 578 general practitioners (GPs). All EDS were investigated in patients (≥ 18 y.o.) consulting over 3 days. Only patients considered a priori as having GERD related EDS were included in study. At each visit (initial and at 1 and 4 months), the diagnostic and therapeutic approach was analyzed, scored, and the GP's certainty regarding the accountability of GER in the EDS rated using the visual analogue scale (VAS). The criteria used by GPs to evaluate GER accountability as certain or doubtful were examined.
  
  
  RESULTS
  Out of 33,487 consulting patients, 14% presented EDS (cough: 6.7%; ENT symptoms: 7.7%; chest pain: 2.3%). Among patients presenting EDS, 22% (1063) were included in the study based on suspicion of GERD, whereas 45% (481) had neither history nor digestive symptoms typically associated with GERD. The diagnostic approach did not vary whether the patient presented typical EDS associated symptoms (A+) or not (A-): 83.7% of patients (A+) versus 86.5% (A-) immediately received acid reflux treatment; 4.6% (A+) versus 7.9% (A-) underwent additional testing and 5.2% (A+) versus 4.4% (A-) were referred to a specialist. In 87% of cases, acid reflux treatment included a proton pump inhibitor (PPI) (half-dose: 47.2%, standard dose 50.3%, double dose 2.5%); in 8.1% of patients initial acid reflux treatment included an H2 antagonist while in 3.2% of patients treatment included prokinetic drugs. At 4 months of follow-up, GERD accountability was considered certain in 74.7% of the patients included in the assessment (794/1063). The GPs opinion was based on response to acid reflux treatment in 92% of cases, on endoscopy in 6.7% of cases, on pH monitoring in 0.3% of cases and on a specialist's opinion in 6% of cases.
  
  
  CONCLUSIONS
  There is a considerable difference between the recommendations of the French-Belgian Consensus Conference on adult GERD and the practices observed in general medicine. The diagnostic and therapeutic approaches were empirical with recourse to additional exams in less than 10% of cases. The degree of certainty as to GERD accountability was based primarily on response to PPI treatment.
authors: Clinique Claude-Bernard, 9, avenue Louis-Armand, 95120 Ermont, France.
authors: Thierry
authors: T
authors: Vallot
authors: Philippe
authors: P
authors: Ducrotte
authors: Bruno
authors: B
authors: Bour
authors: Jean-Paul
authors: JP
authors: Jacques
authors: Philippe
authors: P
authors: Houcke
authors: Jean-Dominique
authors: JD
authors: De Korwin
authors: Alexandre
authors: A
authors: Pariente
authors: Philippe
authors: P
authors: Aygalenq
authors: Bogdana
authors: B
authors: Coudsy
authors: Frédéric
authors: F
authors: Carrois
authors: Léa
authors: L
authors: Ricci
authors: Stanislas
authors: S
authors: Bruley des Varannes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000863:Antacids / Q000627:therapeutic use; D001530:Belgium; D002637:Chest Pain / Q000209:etiology / Q000628:therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data; D004945:Esophagoscopy / Q000706:statistics & numerical data; D005260:Female; D005602:France; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005773:Gastroscopy / Q000706:statistics & numerical data; D058005:General Practitioners / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010038:Otorhinolaryngologic Diseases / Q000209:etiology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012120:Respiration Disorders / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000863:Antacids; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors