Brief Article
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World J Gastroenterol. Sep 21, 2012; 18(35): 4885-4891
Published online Sep 21, 2012. doi: 10.3748/wjg.v18.i35.4885
Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists
Fermín Mearin, Julio Ponce, Marta Ponce, Agustín Balboa, Miguel A González, Javier Zapardiel
Fermín Mearin, Agustín Balboa, Service of Gastroenterology, Centro Medico Teknon, 08022 Barcelona, Spain
Julio Ponce, Digestive Disease Unit, Hospital Quiron, 46010 Valencia, Spain
Julio Ponce, Marta Ponce, Centro de Investigacion Biomedica en Red: Enfermedades Hepaticasy Digestivas, 08036 Barcelona, Spain
Marta Ponce, Service of Gastroenterology, Hospital Universitario La Fe, 46026 Valencia, Spain
Miguel A González, Biostatistics, Innovex-Grupo Quintiles Espana, 28033 Madrid, Spain
Javier Zapardiel, Medical Department AstraZeneca Farmaceutica, 28033 Madrid, Spain
Author contributions: Mearin F studied concept and design, analysed and interpreted the data, drafted the manuscript; Ponce J studied concept and design, analysed and interpreted the data, drafted the manuscript; Ponce M drafted the manuscript; Balboa A analysed and interpreted the data, drafted the manuscript; González MA acquired the data and statistical analysis; Zapardiel J analysed and interpreted the data, drafted the manuscript.
Supported by AstraZeneca Farmaceutica
Correspondence to: Fermín Mearin, MD, PhD, Service of Gastroenterology, Centro Medico Teknon, C/Vilana 12, 08022 Barcelona, Spain. fmearinm@meditex.es
Telephone: +34-93-3933143 Fax: +34-93-3936032
Received: November 7, 2011
Revised: July 24, 2012
Accepted: August 14, 2012
Published online: September 21, 2012
Abstract

AIM: To investigate usefulness of adherence to gastro-esophageal reflux disease (GERD) guideline established by the Spanish Association of Gastroenterology.

METHODS: Prospective, observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily practice. Patients (aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD (heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms, such as dyspeptic symptoms and/or supraesophageal symptoms. Diagnostic and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease specialists.

RESULTS: Endoscopy was indicated in 123 (41%) patients: 50 with alarm symptoms, 32 with age > 50 years without alarm symptom. Seventy-two patients (58.5%) had esophagitis (grade A, 23, grade B, 28, grade C, 18, grade D, 3). In the presence of alarm symptoms, endoscopy was indicated consistently with recommendations in 98% of cases. However, in the absence of alarm symptoms, endoscopy was indicated in 33% of patients > 50 years (not recommended by the guideline). Adherence for proton pump inhibitors (PPIs) therapy was 80%, but doses prescribed were lower (half) in 5% of cases and higher (double) in 15%. Adherence regarding duration of PPI therapy was 69%; duration was shorter than recommended in 1% (4 wk in esophagitis grades C-D) or longer in 30% (8 wk in esophagitis grades A-B or in patients without endoscopy). Treatment response was higher when PPI doses were consistent with guidelines, although differences were not significant (95% vs 85%).

CONCLUSION: GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms; PPIs were prescribed at higher doses and longer duration.

Keywords: Gastro-esophageal reflux disease; Clinical practice guidelines; Adherence to guidelines; Treatment of gastro-esophageal reflux disease