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Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists

World Journal of Gastroenterology 2012年第35期18卷 4885-4891页

作者： Fermín Mearin Julio Ponce Marta Ponce Agustín Balboa Miguel A González Javier Zapardiel Service of Gastroenterology Centro Medico Teknon Digestive Disease Unit Hospital Quiron Centro de Investigacion Biomedica en Red:Enfermedades Hepaticasy Digestivas Service of Gastroenterology Hospital Universitario La Fe Biostatistics Innovex-Grupo Quintiles Espana Medical Department AstraZeneca Farmaceutica

AIM:To investigate usefulness of adherence to gastroesophageal reflux disease(GERD) guideline established by the Spanish Association of ***: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 ***(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 *** 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 ***:Endoscopy was indicated in 123(41%) patients:50 with alarm symptoms,32 with age > 50 years without alarm ***-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 ***,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.

关键词： Gastro-esophageal reflux disease clinicalpractice guidelines Adherence to guidelines Treatmentof gastro-esophageal reflux disease

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