Quality of life in acute and maintenance treatment of non‐erosive and mild erosive gastro‐oesophageal reflux disease

Abstract

Summary Background: Quality of life has been assessed in a large, multicentre randomized, open label study. Aim: To evaluate the economic and clinical consequences of two different maintenance treatment modalities, administered to 6017 gastro‐oesophageal reflux disease patients at 451 gastroenterological centres in Italy. Methods: Adult gastro‐oesophageal reflux disease patients received, at enrolment, an acute treatment of esomeprazole 40 mg/day for 4 weeks and, if successfully treated, were randomized into two maintenance treatment strategies: esomeprazole 20 mg/day or esomeprazole on demand for 6 months. A baseline endoscopy allowed the exclusion of grade II–IV oesophagitis according to Savary–Miller's classification. Burden of gastro‐oesophageal reflux disease was measured at baseline by the generic questionnaire Short‐Form 36 and by a disease specific instrument, quality of life in reflux and dyspepsia (QOLRAD), also administered at start and conclusion of maintenance period. Investigators were required to collect patient judgement about the degree of satisfaction with treatment effect on heartburn, with a 7‐point scale. Results: A comparison between Short‐Form 36 scores and the normative source of the Italian general population suggested that symptomatic gastro‐oesophageal reflux disease patients experience a worse quality of life than the general population. At the end of the 4‐week treatment with esomeprazole 40 mg all (QOLRAD) dimensions showed a statistically significant (P < 0.0001) and clinically meaningful improvement. Satisfaction level towards treatment was reported high in the total enrolled population after acute treatment with esomeprazole 40 mg/day (96.2% satisfied and 64.4% very satisfied). A statistically significant difference in (QOLRAD) scores was registered at the end of maintenance phase in favour of the continuous regimen, nevertheless the size of this difference was very small in all dimensions; similarly, the proportion of patients very satisfied was slightly higher in the continuous treatment arm (64.5%) than in the on‐demand arm (59.7%). Conclusions: Gastro‐oesophageal reflux disease can significantly impair health‐related quality of life and esomeprazole therapy allows immediate relief in the acute phase of the disease. Quality of life improvement was maintained during the 6‐month follow‐up with a slight difference in term of quality of life in reflux and dyspepsia scores and patients’ satisfaction in favour of the continuous treatment strategy.

Recurrence and Its Impact on the Health-related Quality of Life in Patients with Gastroesophageal Reflux Disease: A Prospective Follow-up Analysis

“…12,14,15 Although HRQoL improves with treatment, persistent symptoms after PPI therapy are associated with a reduced HRQoL. 14,16,17 However it is unclear how the recurrence of GERD symptoms impacts patients' HRQoL. Furthermore, there have been no reports regarding the difference in the impact of relapsed GERD symptoms on HRQoL between patients with erosive reflux disease (ERD) and non-erosive reflux disease (NERD).…”

Quality of life in patients with gastroesophageal reflux disease following pharmacotherapeutic, endoscopic, and surgical treatment

“…The level of quality of life in reflux disease was comparable to that observed in mild-degree heart failure [18]. Also, the analyses conducted in Italy, China, Japan, and Australia confirmed that the HRQOL of GERD patients is markedly lower as compared to the general populations of those countries [14,[19][20][21].…”

“…Usually the treatment with PPIs lasts for 2 to 8 weeks [14]. No significant differences were observed between various medications from this group [35], but it should be mentioned that PPIs proved more effective than H2-receptor antagonists [13,35].…”

“…Although GERD is a mild condition, HRQOL in GERD patients is significantly lower than in the general population [12][13][14]. Revicki et al [12] observed that GERD impairs HRQOL in all areas of health analysed with the SF-36 questionnaire.…”

Knowledge and Usage Patterns of Folic Acid amongst Physician Assistant Students at the University of Texas Medical Branch at Galveston.

“…Although disease progression may be a concern in GERD, the number of patients who progress through Barrett's esophagus to esophageal cancer appears to be very small [3]. Despite the low risk for progression to severe disease, clinical trials suggest that the use of on-demand or intermittent antireflux medication can improve quality of life and may regress GERD in response to treatment with these modalities [13][14][15][16]. For example, in one clinical study, symptoms of GERD remained improved after six months in 80.2% and 77.8% of patients who had been randomly assigned to continuous (n=658) and on demand (n=634), respectively following four weeks of once daily medication.…”