Perceptions and Beliefs concerning Gastroesophageal Reflux Disease: Physicians and Patients Disagree

Abstract

Background/Aim: There is insufficient evidence to support an association between lifestyle and gastroesophageal reflux disease (GERD). Furthermore, perceptions concerning the impact of GERD on lifestyle are largely unknown. We aimed at investigating physicians’ perceptions about GERD and lifestyle and at evaluating physician-patient agreement concerning the impact of GERD on the quality of life. Methods: A questionnaire was mailed to all Danish primary care physicians (n = 3,603, response rate 36%) and to all Danish gastroenterologists (n = 624, response rate 50%). Another questionnaire was completed by 176 GERD patients on medical therapy (84% on proton pump inhibitors). Results: 35% of the physicians believe GERD is predominantly caused by lifestyle and 51% always recommend lifestyle modifications. According to the physicians, the three most frequently affected aspects of quality of life were sleep disturbances (24%), limitations in physical activities (22%) and tiredness (18%). However, according to the patients, the three most frequently reported aspects were dietary restrictions (63%), tiredness/lack of energy (49%) and health concerns (44%). 70% of the physicians considered complete absence of symptoms as a useful goal for therapy. 72% of the patients reported recent symptoms, despite therapy and self-imposed lifestyle restrictions. Conclusions: Physicians and GERD patients disagree on impairments of quality of life. Many patients reported frequent symptoms despite therapy and self-imposed lifestyle restrictions.

Is the reflux disease questionnaire useful for identifying GERD according to the Montreal definition?

“…Its implementation depends basically on the physician judging the impact of the symptoms relayed to him by the patient as being or not being troublesome. It is reasonable to surmise that questions about symptom frequency, severity and impact on the patient would have been incorporated into most physicians' anamnesis years ago, and yet there continues to be discordance between physicians' and patients' respective subjective impressions, with disease severity being generally underestimated [11,12,24]. The use of patient-administered questionnaires can thus help physicians ascertain the patients' symptoms more objectively and decide whether such symptoms are indeed troublesome.…”

Review article: rethinking the “ladder” approach to reflux‐like symptom management in the era of PPI “resistance” ‐ a multidisciplinary perspective

“…Supporting data from controlled clinical studies are limited but recommendations included in the latest evidence‐based guidelines include weight loss, smoking cessation, elevating the head of the bed, avoiding dietary triggers (high‐fat, spicy and acidic foods) and not eating close to bedtime 38 . However, evidence suggests that lifestyle advice may not be routinely implemented in general practice 39–41 . Clinicians often incorrectly assume that patients are aware of what constitutes a healthy diet and lifestyle.…”

“…advice may not be routinely implemented in general practice. [39][40][41] Clinicians often incorrectly assume that patients are aware of what constitutes a healthy diet and lifestyle. Perhaps this is because initiating and monitoring behaviour change, especially weight loss, requires motivational interviewing skills, regular contact and encouragement beyond what is feasible in the context of a brief consultation.…”

Knowledge and practice of family medicine and internal medicine residents toward the management of gastroesophageal reflux disease in Riyadh, Saudi Arabia

“…[ 13 ] Additionally, there is usually disagreement between a physician and patient regarding the disease severity, treatment outcome, and the impact on quality of life. [ 14 15 16 ] Moreover, there is a knowledge gap and practice differences in GERD management patients between family physicians and gastroenterologists,[ 17 18 ] and between residents and consultants. [ 19 20 ] Despite these challenges, local data on the physician awareness of GERD management in Saudi Arabia are limited.…”