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| |  Simple Questionnaire Can Help Step-Down Management of Reflux Disease: Presented at UEGW By Jill Stein PARIS, FRANCE -- October 31, 2007 -- For patients with gastroesophageal reflux disease (GERD), a self-administered symptom questionnaire is better than clinical judgment at predicting symptom control and patient satisfaction with symptom relief after reduction from full to half-dose proton pump inhibitor (PPI) therapy, new data show. The findings were reported on October 30 at 15th United European Gastroenterology Week (UEGW). Greg Rubin, MD, Professor of Primary Care, University of Sunderland, Sunderland, UK, and associates compared the performance of the ReQuest in Practice questionnaire with the investigator's clinical judgment in the step-down management of GERD. The ReQuest in Practice questionnaire is a validated and GERD-sensitive questionnaire that is completed by the patient. Participants in the trial received pantoprazole 40 mg/d for 8 weeks followed by 20 mg/d for 8 weeks. The investigators compared the questionnaire's sum score, investigator assessment of symptoms, and patient satisfaction at 8 weeks with patient satisfaction and the questionnaire's sum score at 16 weeks. At week 8, prior to stepping down to half dose, 45% of 211 patients who completed the study were classified to be relieved from symptoms by the questionnaire, whereas 54% remained symptomatic, Dr. Rubin reported. At the 16th week, 45.2% patients were relieved of symptoms. According to doctor assessment, heartburn was relieved in 75.8% patients at 8 weeks, acid regurgitation in 76.8%, dysphagia in 88.6%, and epigastric pain/discomfort in 72.5%. Overall relief rates according to physician assessment were 56% at week 8 and 52.7% at week 16. In the study, a patient was defined as having overall relief if the intensity for each symptom was assessed as "none." At week 8, the doctor assessed 79% patients as ready to decrease or stop treatment with 20 mg pantoprazole. The questionnaire's sum score at 8 weeks was a better predictor of successful PPI dose reduction than physician assessment as measured by positive likelihood ratio and positive predictive value. In addition, the prediction of the questionnaire's sum score at week 8 with respect to symptom relief at week 16 was more accurate than the physician's judgment on dose reduction. Similarly, the questionnaire sum score was a better predictor of patient satisfaction at week 16 than assessment by the doctor. "Physicians tend to overestimate the 'readiness' of patients for step-down PPI treatment in GERD," Dr. Rubin observed. Overall, the results show that the use of the ReQuest in Practice questionnaire can help physicians improve their decision-making vis-à-vis the step-down management of GERD patients, he added. The study, sponsored by Altana Pharma, was conducted in 34 general practice centres in the UK.
[Presentation Title: A Short Symptom Questionnaire Can Improve Decision-Making in the Step-Down Management of Gastroesophageal Reflux Disease (GERD). Abstract G-113]
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