Unmet Medical Needs among Patients with Gastroesophageal Reflux Disease: A Foundation for Improving Management in Primary Care

Abstract

Gastroesophageal reflux disease (GERD) is a common disease that has a significant impact on patients’ health-related quality of life. While proton pump inhibitors have transformed GERD therapy, effective management of this disease is still a challenge. This review consolidates data from the recently published Burning Questions and Burning Desires surveys to provide a foundation for improved primary care management of GERD. First, the surveys confirm the significant troublesome impact of GERD on patients’ health-related quality of life. Negative effects on sleeping and eating were identified as the leading causes for concern among such patients. Second, a lack of symptom control was identified among patients receiving physician-guided care for GERD, with many patients experiencing persistent symptoms. This was likely to be responsible for the third major finding of these surveys – the high rate of concomitant over-the-counter medication use among patients receiving prescription therapy. The surveys also uncovered a disconnect between patients and physicians in terms of GERD symptom severity, and perceptions of GERD and its treatment. Such findings outline the requirement for improved management of GERD, including the need to identify patients who may benefit from reassessment and more effective therapies. Patient-reported, questionnaire-based tools may aid physicians in this regard.

What causes treatment failure - the patient, primary care, secondary care or inadequate interaction in the health services?

“…In addition to the same criticisms, secondary care was blamed for inaccurate diagnostics and lack of referral to other specialists. It is known that these patients have uncovered needs for health services [2,3]. The problem seems to be the communication between the patient and the doctor.…”

“…The problem seems to be the communication between the patient and the doctor. The doctor does not grasp the symptom severity, sleep disorders, eating problems, high use of over the counter drugs and reduced quality of life, and does not perceive the patient's incorrect understanding of causes, treatment and prognosis [2,11,12]. Highly effective health services with focus on number of procedures (gastroscopies) at the expense of communication with and clinical follow-up of the patients could in part explain the problems.…”

“…Patients with GERD followed up in meticulously performed clinical trials achieve nearly without exception symptomatic relief and normalized quality of life [1]. In contrast, experience from daily practice and pragmatic studies shows that a substantial proportion of the patients have significant and persisting complaints and reduced quality of life despite treatment in primary and secondary care [2-5]. Overall, this is a significant problem for the health care and the patients since the prevalence of potentially curable disorders is high, e.g the prevalence of GERD is 10-20% [6].…”

Non-pharmacological intervention for gastro-oesophageal reflux disease in primary care

“…25 If this is the case, maintaining patients on, or weaning them off PPIs without giving them a means of managing their symptoms will be very difficult. If, as suggested, the way forward with reflux management is to use more than one approach, 9,26 an education intervention alongside a carefully managed PPI programme 27 may have the potential to reduce the long-term use of PPIs and avoid the problem of rebound acid production as well as improving quality of life.…”

Alginates in therapy for gastroesophageal reflux disease

“…Примерно для 20-30% больных, особенно с неэрозивной ГЭРБ и (или) внепище-водными ее проявлениями, исходно характерен плохой ответ на терапию ИПП [20][21][22]. Среди причин, определяющих недоста-точную эффективность ИПП, называют низкую приверженность лечению, снижение биодоступности и быстрый метаболизм ИПП, истинную резистентность к ИПП, ночной кислотный про-рыв, постпрандиальный кислотный карман.…”