title: The Changing Impact of Gastroesophageal Reflux Disease in Clinical Practice.
abstract: OBJECTIVE
  The National Ambulatory Medical Care Survey (NAMCS) database was utilized to understand evolving national trends in diagnosis and management of reflux.
  
  
  METHODS
  The NAMCS database was queried for visits related to gastroesophageal reflux diagnosis and management. Analysis performed for time periods 1998-2001, 2002-2005, and 2006-2009 was weighted to provide national estimates of care. Results were compared to previously reported time periods from 1990 to 2001 to evaluate patterns in overall visits, age and ethnicity of patients, provider type, and prescriptions provided.
  
  
  RESULTS
  The number of ambulatory visits for reflux increased from 8 684 000 in 1998-2001 to 15 750 000 in 2006-2009. Visits increased across each time period for internal medicine, family, and gastroenterology physicians. Among otolaryngologists, absolute visits increased from 1998-2001 to 2002-2005 but decreased in 2006-2009; difference between these time periods did not reach statistical significance. From 1998-2001 to 2006-2009, reflux medication use increased 233%, with continuing trends toward increased proton pump inhibitor use.
  
  
  CONCLUSIONS
  Reflux visits have increased across all demographic subgroups studied. Knowledge of these trends may inform further paradigm shifts in diagnosis and management of reflux.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Akst
authors.affiliation: 2 Mayo Medical School, Rochester, Minnesota, USA.
authors.forename: Omar J
authors.initials: OJ
authors.lastname: Haque
authors.affiliation: 3 Department of Medicine, Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: John O
authors.initials: JO
authors.lastname: Clarke
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Hillel
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Simon R A
authors.initials: SR
authors.lastname: Best
authors.affiliation: 4 Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Altman
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: NAMCS; gastroesophageal reflux; laryngopharyngeal reflux; reflux