Accounting for the effect of GERD symptoms on patients' health-related quality of life: supporting optimal disease management by primary care physicians

Abstract

Aim: To review, from a primary care physician (PCP) perspective, the use of patient-reported outcome (PRO) instruments for assessment of gastro-oesophageal reflux disease (GERD) symptoms, their impact on health-related quality of life (HRQL) and the effectiveness of therapy.

Results: While generic and disease-specific PRO instruments have been used in the assessment of GERD, the latter can be considered to be more appropriate as they focus only on problems relevant to the disease in question (and therefore tend to be more responsive to change). Such instruments include the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire and the Gastrointestinal Symptom Rating Scale and the Reflux Disease Questionnaire (RDQ). Their use indicates that GERD symptoms are troublesome and significantly reduce patients' HRQL, and that effective treatment of GERD improves HRQL. The GERD Impact Scale (GIS) questionnaire, primarily developed for use within primary care, can also help to determine the impact of symptoms on patients' everyday lives and, in turn, the benefit of appropriately targeted therapy. Notably, these PRO instruments were developed from focus groups of GERD patients, and only aspects rated of highest importance are used in the final instruments. Consequently, PCPs can feel confident that these questionnaires encompass the most relevant points that they are likely to ask in terms of how symptoms affect patients' everyday lives.

Conclusions: Primary care physicians are encouraged to make wider use of PRO instruments within routine practice to improve communication with their GERD patients that, in turn, could lead to improved clinical outcomes and greater patient satisfaction.

Figure 1

The GERD Impact Scale (available at: http://www.nexium.net/hcp/ScientificResources/The-GERD-Impact-Scale.aspx?mid=35)

Figure 2

Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire dimensions, assessed prior to treatment and after 2 weeks of treatment with esomeprazole, in German patients with symptoms suggestive of gastro-oesophageal reflux disease; p < 0.0001 for all changes vs. pretreatment (baseline) (23). Reprinted from Kulig M, et al. Quality of life in relation to symptoms in patients with gastro-oesophageal reflux disease – an analysis based on the ProGERD initiative. Aliment Pharmacol Ther 2003; 18: 767–76, with permission from Blackwell Publishing. RE, reflux oesophagitis (patients received esomeprazole 40 mg/day for 4 weeks in total); NERD, non-erosive reflux disease (patients received esomeprazole 20 mg/day for 2 weeks)