Impact of gastroesophageal reflux disease on patients' daily lives: a European observational study in the primary care setting

Abstract

Background: The impact of gastroesophageal reflux disease (GERD) on the daily lives of patients managed in primary care is not well known. We report the burden of GERD in a large population of patients managed in primary care, in terms of symptoms and impact on patients' daily lives.

Methods: RANGE (Retrospective ANalysis of GERD) was an observational study that was conducted at 134 primary care sites across six European countries. All adult subjects who had consulted their primary care physician (PCP) during a 4-month identification period were screened retrospectively and those consulting at least once for GERD-related reasons were identified. From this population, a random sample of patients was selected to enter the study and attended a follow-up appointment, during which the Reflux Disease Questionnaire (RDQ), the GERD Impact Scale (GIS) and an extra-esophageal symptoms questionnaire were self-administered. Based on medical records, data were collected on demographics, history of GERD, its diagnostic work-up and therapy.

Results: Over the 4-month identification period, 373,610 subjects consulted their PCP and 12,815 (3.4%) did so for GERD-related reasons. From 2678 patients interviewed (approximately 75% of whom reported taking medication for GERD symptoms), symptom recurrence following a period of remission was the most common reason for consultation (35%). At the follow-up visit, with regard to RDQ items (score range 0-5, where high score = worse status), mean Heartburn dimension scores ranged from 0.8 (Sweden) to 1.2 (UK) and mean Regurgitation dimension scores ranged from 1.0 (Norway) to 1.4 (Germany). Mean overall GIS scores (range 1-4, where low score = worse status) ranged from 3.3 (Germany) to 3.5 (Spain). With regard to extra-esophageal symptoms, sleep disturbance was common in all countries in terms of both frequency and intensity.

Conclusion: In this large European observational study, GERD was associated with a substantial impact on the daily lives of affected individuals managed in the primary care setting.

Figure 1

Study design and patient flow. GERD, gastroesophageal reflux disease.

Figure 2

Mean (standard deviation) Reflux Disease Questionnaire scores, by country of residence. Scores range from 0 to 5, with higher scores indicating more frequent and/or severe symptoms.

Figure 3

Mean (standard deviation) GERD Impact Scale scores, by country of residence. Scores range from 1 to 4, with lower scores indicating increased frequency/impact of symptoms. GI, gastrointestinal.

Figure 4

Mean (standard deviation) Extra-esophageal Symptoms Questionnaire frequency scores, by country of residence. Scores range from 0 to 5, with higher scores indicating more frequent symptoms.

Figure 5

Mean (standard deviation) Extra-esophageal Symptoms Questionnaire intensity scores, by country of residence. Scores range from 0 to 5, with higher scores indicating more severe symptoms.