title: [Insufficient symptom control under long-term treatment with PPI in GERD - fact or fiction?].
abstract: BACKGROUND
  Randomized controlled trials show that patients with gastroesophageal reflux disease (GERD) and treatment with proton pump inhibitors (PPI) in about 30% of the cases complain about persisting reflux symptoms (heartburn, regurgitation). The aim of the study was to evaluate the efficacy of PPI long-term treatment in patients with GERD in the family doctor's office.
  
  
  METHODS
  Patients with GERD and a PPI therapy of at least one year participated in a prospective, multicenter observational study. The patients obtained a questionnaire together with a further prescription of PPI. They were asked about the intensity and frequency of heartburn, regurgitation and sleep disorders due to reflux symptoms, satisfaction with PPI therapy, diagnostics performed up to now (endoscopy, pH monitoring, manometry) and surgical consultation. The questionnaire included a validated instrument for the diagnosis of GERD (GerdQ). Patients with the diagnosis "GERD " according to the questionnaire who were very dissatisfied with their current PPI therapy (score 1 or 2 on a 5-point Likert scale) were defined as "lost patients " (LOPA).
  
  
  RESULTS
  39% of the patients still suffered from heartburn at least two days a week, 30% of regurgitation. In 22% of the patients, reflux symptoms led to sleep disorder at least two days a week. 20% of the patients were very dissatisfied with the current PPI therapy. 70% of them (= 14% of the total patient population) were "lost patients " according to the definition. An endoscopy was performed in 86% of the patients and function diagnosis (pH monitoring ± manometry) in 8%. A surgeon was consulted in 8% of the patients, a third of which had received function diagnosis before.
  
  
  CONCLUSIONS
  A poor symptom control can often be found in GERD patients with PPI long-term therapy, but does not stand out in the daily routine. So diagnosis will not continue and treatment alternatives will not be searched for. In the future quality of treatment should be verified e. g. by questionnaires.
authors.affiliation: Refluxzentrum Siegerland, Medizinische Klinik, Diakonie Klinikum GmbH, Jung-Stilling-Krankenhaus, Wichernstr. 40, 57074, Siegen, Deutschland. J.Labenz@t-online.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Labenz
authors.affiliation: Refluxzentrum Siegerland, Medizinisches Zentrum am Siegerland-Flughafen, Burbach, Deutschland.
authors.forename: Gisela
authors.initials: G
authors.lastname: Labenz
authors.affiliation: Refluxzentrum Siegerland, Chirurgische Klinik, St. Marien-Krankenhaus, Siegen, Deutschland.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Stephan
authors.affiliation: Refluxzentrum Siegerland, Chirurgische Klinik, St. Marien-Krankenhaus, Siegen, Deutschland.
authors.forename: Frank
authors.initials: F
authors.lastname: Willeke
mesh_terms: D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy*; D019983:Guideline Adherence; D006801:Humans; D008134:Long-Term Care; D017060:Patient Satisfaction; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D017211:Treatment Failure
chemical_list: D054328:Proton Pump Inhibitors
keywords: gastroesophageal reflux disease (GERD); proton pump inhibitors (PPI); questionnaire; symptom control