Nighttime Heartburn in Patients with Gastroesophageal Reflux Disease under Routine Care

Abstract

Background: Gastroesophageal reflux disease (GERD) is a common disorder. The aim of our study was to describe the prevalence of nighttime heartburn and its associations with esophagitis, Barrett’s esophagus, and extra-esophageal symptoms. Methods: Data were collected as part of the ongoing Progression of Gastroesophageal Reflux Disease (ProGERD) study. Based on endoscopy results, patients were categorized as having nonerosive GERD, erosive GERD, or Barrett’s esophagus. ORs and 95% CIs derived from logistic regression analysis were calculated for the association between nighttime heartburn and GERD complications. Results: The overall prevalence of nighttime heartburn for at least 1 of 3 years was 49%, and 21% of patients reported nighttime heartburn in all 3 years. According to multivariate analysis, chronic nighttime heartburn was associated with globus sensation (OR 1.79, 95% CI 1.29–2.47) and erosive GERD (OR 1.67, 95% CI 1.29–2.15). Compared to continuous proton pump inhibitor (PPI) intake, noncontinuous PPI therapy (OR 2.26, 95% CI 1.73–2.96) and medication other than PPIs (OR 2.46, 95% CI 1.67–3.62) were also associated with chronic nighttime heartburn. Conclusions: The prevalence of nighttime heartburn in GERD patients under routine care was high, even in patients on continuous PPI therapy. Nighttime heartburn was not associated with Barrett’s esophagus or most extra-esophageal symptoms.

Serum gastrin and pepsinogens do not correlate with the different grades of severity of gastro‐oesophageal reflux disease: a matched case–control study

“…The ProGERD study is a prospective, multi‐centre, open cohort study, in which patients with GERD are being followed up after treatment with esomeprazole 12–24 . Briefly, the patients from the ProGERD study were divided as follows: NERD, n = 2853 (no erosions, no endoscopic or histological BO); Los Angeles (LA) AB, n = 2256 (LA A or B, no BO), LA CD, n = 404 (ERD according to LA classification, no BO); and BO (endoscopic and histological diagnosis of BO), n = 305 12 .…”

“…Patients were eligible for the ProGERD study if they were at least 18 years of age, reported heartburn as their main symptom and were referred for esophagogastroduodenoscopy (EGD) because of reflux symptoms. Details of recording of the general and medical history have been published previously 12–24 . Exclusion criteria were: history of gastrointestinal surgery and/or gastro‐oesophageal malignancies; continuous treatment with any acid‐suppressive drug for more than 7 days within the last 4 weeks prior to inclusion; contraindications to esomeprazole treatment; any ‘alarm symptoms’ of malignancy or other significant cardiovascular, pulmonary (e.g.…”

Health‐related quality of life in patients with gastro‐oesophageal reflux disease under routine care: 5‐year follow‐up results of the ProGERD study

“…Night-time heartburn is common in GERD patients and is associated with reduced well-being. [18][19][20] A Gallup survey, for example, found that subjects with nocturnal symptoms had impaired daytime functioning. 20 Accordingly, frequent nocturnal symptoms among patients with GERD are associated with a loss in work productivity.…”

Facts and fantasies in extra-oesophageal symptoms in GORD

“…[53] Moreover, almost 50% of patients with known GORD report nocturnal heartburn under the routine clinical care provided by their GPs. [54] Nocturnal symptomatic gastro-oesophageal reflux can lead to difficulty in getting to sleep and remaining asleep, and to daytime fatigue and impaired work productivity. Polysomnography reveals, in particular, brief wake phases and shortening of the second sleep phase.…”