Original Article
The American Journal of Gastroenterology (2005) 100, 1237–1242; doi:10.1111/j.1572-0241.2005.41364.x
Primary-Care Physicians' Perceptions and Practices on the Management of GERD: Results of a National Survey
This work has been presented in part at the annual meeting of the American College of Gastroenterology in Seattle, WA, in October 2002, and at the annual meeting of the American Gastroenterological Association at Digestive Disease Week in Orlando, FL, in May 2003. Parts of this work have, therefore, been published in abstract form (Chey et al., Am. J. Gastroenterol. 2002: 97: S231–2; Chey et al., Gastroenterology 2003; 124: A-108, Chey et al., Gastroenterology 2003; 124: A-505).
William D Chey MD, FACG1, John M Inadomi MD1, Anna M Booher MD1, Virender K Sharma MD1, A Mark Fendrick MD1 and Colin W Howden MD, FACG1
1University of Michigan Health System, Ann Arbor, Michigan; Mayo Clinic, Scottsdale, Arizona; Northwestern University Feinberg School of Medicine, Chicago, Illinois
Correspondence: William D Chey, MD, FACP, FACG, Associate Professor of Internal Medicine, University of Michigan Health System, 3912 Taubman Center, Ann Arbor, MI 49109–0362
Received 17 August 2004; Revised 0000; Accepted 16 December 2004.
Abstract
BACKGROUND:
Gastroesophageal reflux disease (GERD) is frequently managed by primary-care physicians (PCPs) although little is known about their current practices and management patterns.
METHODS:
We administered a questionnaire-based survey to PCPs attending sponsored educational conferences on GERD. Questionnaires were completed anonymously before the conferences and asked about prescribing patterns, indications for surgical referral, and issues concerning Barrett's esophagus and H. pylori infection.
RESULTS:
A total of 1046 completed questionnaires (97% acceptance rate) were received. Most PCPs prescribed a proton pump inhibitor (PPI) for GERD without prior authorization and without first using an H2-receptor antagonist (H2RA). Many gave an H2RA with once-daily PPI treatment for patients with nocturnal heartburn. Most referrals for anti-reflux surgery were for inadequate response to medical treatment, although PCPs usually first sought gastroenterological consultation. There was a widespread acceptance of screening GERD patients for Barrett's esophagus. There was general confusion about any relationship between H. pylori infection and GERD; 80% of PCPs tested for the infection in at least some patients who only had symptoms of GERD.
CONCLUSIONS:
Our survey has identified a number of areas of controversy and confusion related to the management of GERD. We hope that our findings can assist in the development of educational materials on GERD for PCPs.
