Perceptions and practices on the management of gastro‐oesophageal reflux disease: results of a national survey comparing primary care physicians and gastroenterologists

Bretagne, Jean–François; Honnorat, Charles; Richard-Molard, B.; Soufflet, Christine; Barthélémy, Philippe

doi:10.1111/j.1365-2036.2007.03265.x

Cited by 19 publications

(21 citation statements)

References 33 publications

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“…One third of the doctors consider GERD to be predominantly caused by lifestyle and nearly all physicians always or frequently recommend lifestyle changes as part of the treatment. These results are consistent with a recent study showing that a number of lifestyle changes were recommended to patients by French primary care and specialist physicians [9]. This approach is supported by guidelines on GERD management [10].…”

Section: Discussionsupporting

confidence: 82%

“…This finding is in accordance with results from a primary care based telephone interview study from USA, Japan and Europe, which found that only 36% of the GERD patients receiving prescription therapy reported that they were currently asymptomatic [11]. Remarkably, survey data indicate that clinicians estimate symptom persistence after treatment to occur on average in only 14% of the patients [9]. …”

Section: Discussionsupporting

confidence: 77%

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

Reimer

Bytzer²

2007

Digestion

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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.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 77%

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

Reimer

Bytzer²

2007

Digestion

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“…A relevant Pan-European study showed that the majority of PCPs (varying from 51% in the UK to 84% in Czech Republic) were aware of the test with PPI as a method of diagnosing GERD, but the daily PPI dose used by them for this test ranged from maintenance dose to fourfold standard treatment dose, over a period that ranged from 1 to 13 weeks 50. Earlier studies showed that PCPs preferred a step-up strategy beginning with antacids or H2-receptor antagonists and progressing to PPIs for patients who fail to respond to therapy,67,68 while the more recent studies show that the majority of PCPs tend to begin with the most efficacious therapy with PPIs and then taper the dose down to the lowest dose that controls symptoms (step-down strategy) 69,70. In addition, GEs are uniformly likely to use a step-down therapy regimen.…”

Section: The Role Of Pcps In Early Diagnosis and Management Of Patienmentioning

confidence: 99%

The role of primary care physicians in early diagnosis and treatment of chronic gastrointestinal diseases

Gikas¹,

Triantafillidis²

2014

IJGM

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Chronic gastrointestinal disorders are a source of substantial morbidity, mortality, and cost. They are common in general practice, and the primary care physician (PCP) has a central role in the early detection and management of these problems. The need to make cost-effective diagnostic and treatment decisions, avoid unnecessary investigation and referral, provide long-term effective control of symptoms, and minimize the risk of complications constitute the main challenges that PCPs face. The literature review shows that, although best practice standards are available, a considerable number of PCPs do not routinely follow them. Low rates of colorectal cancer screening, suboptimal testing and treatment of Helicobacter pylori infection, inappropriate use of proton pump inhibitors, and the fact that most PCPs are still approaching the irritable bowel disease as a diagnosis of exclusion represent the main gaps between evidence-based guidelines and clinical practice. This manuscript points out that updating of knowledge and skills of PCPs via continuing medical education is the only way for better adherence with standards and improving quality of care for patients with gastrointestinal diseases.

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“…In 2,000 patients experiencing heartburn, two-thirds of respondents with recurring or persisting symptoms sought physician advice at least once [54]. In another survey, however, most physicians (87%) reported infrequent or no persistence of GERD symptoms after treatment with PPIs [55].…”

Section: Is There Any Risk Of Continuous Self-medication (Beyond 14 Dmentioning

confidence: 98%

Guidance on the use of over-the-counter proton pump inhibitors for the treatment of GERD

et al. 2011

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As defined by the treatment algorithm, the pharmacist should first confirm the diagnosis based on the presence of typical symptoms and secondly, as a result, rule out general practitioner referral. The third step focuses on the nature, severity and frequency of the symptoms--the patients who might have the highest benefit from a short course (14 days) of OTC PPIs are those with less than three episodes of heartburn and/or acid regurgitation per week. Patients who have three or more episodes per week can use the OTC PPIs but should also be encouraged to visit a physician, and those who already have a diagnostic work-up can use proton pump inhibitors as rescue treatment if they are known responders. Guidance for pharmacists, in the form of questions and answers, summarises the current published clinical experience with PPIs in terms of their efficacy and safety, and optimal treatment schedule. Conclusions Gastroesophageal reflux disease imposes a considerable burden on sufferers. Owing to their accepted efficacy and safety, PPIs are becoming popular as OTC options for the treatment of gastroesophageal reflux disease symptoms such as heartburn and acid regurgitation. Effective self-management of gastroesophageal reflux disease with OTC PPIs, e.g. omeprazole, could lead to lasting freedom from symptoms and improved quality of life for sufferers.

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Perceptions and practices on the management of gastro‐oesophageal reflux disease: results of a national survey comparing primary care physicians and gastroenterologists

Abstract: SUMMARY BackgroundLiterature comparing generalist and specialist care is accumulating in many disease areas, but very few studies focussed on gastrointestinal diseases and little is known about gastro-oesophageal reflux disease.

Cited by 19 publications

References 33 publications

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

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

The role of primary care physicians in early diagnosis and treatment of chronic gastrointestinal diseases

Guidance on the use of over-the-counter proton pump inhibitors for the treatment of GERD

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