Quality of life in patients receiving treatment for gastro‐oesophageal reflux disease

Drug treatment improves quality of life in patients suffering from gastro‐oesophageal reflux disease Patients receiving omeprazole 20mg once daily reported the greatest improvement in quality of life The pharmacist could use quality of life measurement instruments in disease management to monitor effectiveness of drug therapy and to improve patients' quality of life     

Management of gastro‐oesophageal reflux in infants

The management of gastro‐oesophageal reflux in infants was evaluated There is variation in current practice in the management More emphasis needs to be made on the significance of lifestyle changes in gastro‐oesophageal reflux Use of pharmacological agents indicates the need to establish management guidelines     

Meta‐analysis: the effects of placebo treatment on gastro‐oesophageal reflux disease

Aliment Pharmacol Ther 2010; 32: 29–42

Summary

Background There appears to be a significant placebo response rate in clinical trials for gastro‐oesophageal reflux disease. Little is known about the determinants and the circumstances associated with placebo response in the treatment of gastro‐oesophageal reflux disease (GERD). Aims To estimate the magnitude of the placebo response rate in randomized controlled trials for GERD and to identify factors that influence this response. Methods A meta‐analysis of randomized, double‐blind, placebo‐controlled trials, published in English language, which included >20 patients with GERD, treated with either a proton pump inhibitor or H₂‐receptor antagonist for at least 2 weeks. Medline, Cochrane and EMBASE databases were searched, considering only studies that reported a global response for ‘heartburn’. Results A total of 24 studies included 9989 patients with GERD. The pooled odds ratio (OR) for response to active treatment vs. placebo was 3.71 (95% CI: 2.78–4.96). The pooled estimate of the overall placebo response was 18.85% (range 2.94%–47.06%). Patients with erosive oesophagitis had a non‐significantly lower placebo response rate than patients without it (11.87% and 18.31%, respectively; P = 0.246). Placebo response was significantly lower in studies of PPI therapy vs. studies of H₂ RAs ( 14.51% vs. 24.69%, respectively; P = 0.05). Conclusions The placebo response rate in randomized controlled trials for GERD is substantial. A lower placebo response was associated with the testing of PPIs, but not the presence of erosive oesophagitis.     

Clinical trial: esomeprazole for moderate‐to‐severe nighttime heartburn and gastro‐oesophageal reflux disease‐related sleep disturbances

Aliment Pharmacol Ther 2010; 32: 182–190

Summary

Background Nighttime heartburn, common among patients with gastro‐oesophageal reflux disease (GERD), is associated with substantial clinical effects. GERD‐related sleep disturbances are underappreciated and undertreated. Aim To evaluate the efficacy of esomeprazole on GERD‐related nighttime heartburn and associated sleep disturbances. Methods In this multicentre, randomized, double‐blind, placebo‐controlled study, patients with moderate‐to‐severe nighttime heartburn and GERD‐related sleep disturbances (endoscopies not required) received esomeprazole 20 mg or placebo each morning for 4 weeks. Heartburn symptoms and GERD‐related sleep disturbances were evaluated using the validated Pittsburgh Sleep Quality Index and validated Work Productivity and Activity Impairment Questionnaire. Results The analysis included 262 patients (esomeprazole, n = 137; placebo, n = 125). Significantly more patients receiving esomeprazole achieved nighttime heartburn relief (primary end point) than those receiving placebo (34.3% vs. 10.4%; P < 0.0001). Secondary end points such as relief of GERD‐related sleep disturbances (P = 0.006), days without GERD‐related sleep disturbances (P = 0.0003) and complete resolution of sleep disturbances (P < 0.0001) favoured esomeprazole over placebo. Sleep quality, work productivity and regular daily activities also improved significantly with esomeprazole vs. placebo. Conclusions Esomeprazole 20 mg is effective for patients with moderate‐to‐severe nighttime heartburn and GERD‐related sleep disturbances, improving heartburn symptoms, sleep quality, work productivity and functionality.

     

Systematic review: the effects of carbonated beverages on gastro‐oesophageal reflux disease

Aliment Pharmacol Ther 31 , 607–614

Summary

Background Carbonated beverages have unique properties that may potentially exacerbate gastro‐oesophageal reflux disease (GERD), such as high acidity and carbonation. Cessation of carbonated beverage consumption is commonly recommended as part of lifestyle modifications for patients with GERD. Aims To evaluate the relationship of carbonated beverages with oesophageal pH, oesophageal motility, oesophageal damage, GERD symptoms and GERD complications. Methods A systematic review. Results Carbonated beverage consumption results in a very short decline in intra‐oesophageal pH. In addition, carbonated beverages may lead to a transient reduction in lower oesophageal sphincter basal pressure. There is no evidence that carbonated beverages directly cause oesophageal damage. Carbonated beverages have not been consistently shown to cause GERD‐related symptoms. Furthermore, there is no evidence that these popular drinks lead to GERD complications or oesophageal cancer. Conclusions Based on the currently available literature, it appears that there is no direct evidence that carbonated beverages promote or exacerbate GERD.     

The influence of environmental risk factors in hospitalization for gastro‐oesophageal reflux disease‐related diagnoses in the United States

Aliment Pharmacol Ther 31 , 852–861

Summary

Background The impact of gastro‐oesophageal reflux disease on hospitalization is unknown. Aim To describe the characteristics of patients hospitalized for diagnoses related to gastro‐oesophageal reflux disease (GERD) and find potential environmental influences that affect their hospitalization. Methods Data from the Healthcare Cost and Utilization Project were used to study the demographic characteristics of hospitalizations associated with GERD during 2003–2006. Data from the Centers for Disease Control were used for information about the US prevalence of obesity. Results During 2003–2006, 0.5 million patients with a primary and 14.5 million patients with a secondary GERD‐related diagnosis became hospitalized in the US. Oesophageal reflux and hiatal hernia were more common in female than in male inpatients, whereas Barrett’s oesophagus and oesophageal adenocarcinoma were more common in male than in female inpatients. All GERD‐related diagnoses were more common in white people than non‐white people. Hospitalizations associated with oesophageal reflux, reflux oesophagitis and Barrett’s oesophagus showed resembling geographical distributions among different US states. The prevalence of obesity and the hospitalization for hiatal hernia or reflux oesophagitis were also characterized by similar geographical distributions. Conclusion The large numbers of inpatients with a discharge diagnosis of GERD‐related conditions attest to the frequent occurrence and relevance of GERD in contributing to hospitalization in the US.     

Systematic review: the association between symptomatic response to proton pump inhibitors and health‐related quality of life in patients with gastro‐oesophageal reflux disease

Aliment Pharmacol Ther 2011; 34: 618–627

Summary

Background Some patients with gastro‐oesophageal reflux disease (GERD) experience persistent reflux symptoms on proton pump inhibitor (PPI) therapy. The relationship between persistent reflux symptoms and health‐related quality of life (HRQoL) is unclear. Aim To assess the relationship between persistent reflux symptoms on PPI therapy and HRQoL in patients with GERD. Methods Systematic searches were conducted in PubMed and Embase. Eligible studies had to have used psychometrically evaluated patient reported outcome instruments to assess HRQoL. Results Nine studies were included; supplementary data were obtained for four of these. The effect of persistent reflux symptoms despite PPI therapy on physical HRQoL was assessed in seven studies and that on mental HRQoL in five studies. Compared with patients whose reflux symptoms responded to PPIs, those with persistent symptoms had, on average, 8–16% lower scores for physical health (five studies) and 2–12% lower scores for mental health (three studies). Three studies included data on the effect of baseline HRQoL on subsequent symptomatic response to PPI therapy. Patients with persistent symptoms had clinically relevant lower psychological well‐being at baseline compared with those whose symptoms responded to PPIs (average score difference: 7%; two studies). High anxiety levels at baseline seemed to be an important aspect of persistent symptoms. Conclusions Persistent reflux symptoms on PPI therapy are associated with reduced physical and mental HRQoL, while reduced mental HRQoL at baseline seems to impair symptomatic response to PPIs. HRQoL may need to be considered alongside reflux symptom frequency and severity when making decisions about disease management.     

Systematic review: role of acid,weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease

Aliment Pharmacol Ther 2010; 32: 334–343

Summary

Background The importance of weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease (GERD) is gaining recognition. Aim To quantify the proportions of reflux episodes that are acidic (pH <4), weakly acidic (pH 4–7) and weakly alkaline (pH >7) in adult patients with GERD, and to evaluate their correlation with symptoms. Methods Studies were identified by systematic PubMed and Embase searches. Data are presented as sample‐size weighted means and 95% confidence intervals. Results In patients with GERD taking a proton pump inhibitor (PPI), 80% (76–84%) of reflux episodes were weakly acidic or weakly alkaline and 83% (78–88%) of reflux symptom episodes were associated with weakly acidic or weakly alkaline reflux episodes. In patients with GERD not taking a PPI, 63% (59–67%) of reflux episodes were acidic and 72% (57–87%) of reflux symptom episodes were associated with acid reflux episodes. Six studies presented data separately for weakly alkaline reflux, which accounted for <5% of all reflux episodes, both on and off PPI therapy. Conclusions Weakly acidic reflux underlies the majority of reflux episodes in patients with GERD on PPI therapy, and is the main cause of reflux symptoms occurring despite PPI therapy.     

Depression and treatment with antidepressants are associated with the development of gastro‐oesophageal reflux disease

Aliment Pharmacol Ther 31 , 1132–1140

Summary

Background The roles of depression and antidepressants in triggering reflux symptoms remain unclear. Aim To compare the incidence of gastro‐oesophageal reflux disease (GERD) in individuals with and without a depression diagnosis and to evaluate risk factors for a GERD diagnosis. The relationship between antidepressant treatment and GERD was also assessed. Methods The Health Improvement Network UK primary care database was used to identify patients with incident depression and an age‐ and sex‐matched control cohort with no depression diagnosis. Incident GERD diagnoses were identified during a mean follow‐up of 3.3 years. Furthermore, we performed nested case‐control analyses where odds ratios (OR) with 95% confidence intervals (CI) were estimated by unconditional logistic regression in multivariable models. Results The incidence of GERD was 14.2 per 1000 person‐years in the depression cohort and 8.3 per 1000 person‐years in the control cohort. The hazard ratio of GERD in patients with depression compared with controls was 1.72 (95% CI: 1.60–1.85). Among patients with depression, tricyclic antidepressant use was associated with an increased risk of GERD (OR: 1.71; 95% CI: 1.34–2.20), while selective serotonin reuptake inhibitors were not associated with GERD. Conclusions A depression diagnosis is associated with an increased risk of a subsequent GERD diagnosis, particularly in individuals using tricyclic antidepressants.