Therapeutic management of uncomplicated gastroesophageal reflux disease in france in 2005: Potential cost savings of omeprazole substitution

AbstractGastroesophageal reflux disease (GERD) is one of the most common chronic gastrointestinal ailments worldwide, with a high prevalence and extremely costly diagnostic and therapeutic management. A hygienic-dietary regimen, accompanied by weight loss, are important factors for improving the symptoms of reflux disease. Various ways of correct diagnosis and for therapeutic management have been attempted over the years, of which themost widely used diagnostic method is empirical therapy with proton pump inhibitors. Also, questionnaires, upper digestive endoscopy with biopsies, barium radiography, ambulatory monitoring of esophageal pH, pH-impedance and esophageal manometry are widely used. Upper gastrointestinal endoscopy has a good specificity, but a low sensitivity for GERD. Also, the GERQ questionnaire has a good sensitivity and specificity in the accuracy of GERD diagnostic. Barium swallow use belongs to the past, and is recommended mostly for the detection of anatomical anomalies and not for the diagnosis of reflux disease. 24-hour ambulatory monitoring of esophageal pH is the study of choice to confirm the diagnosis of reflux disease in patients without endoscopic modifications suggestive of GERD. The association of impedance to esophageal pH monitoring is the gold standard for diagnosing GERD, making it possible to differentiate between acid reflux, weakly acid and non-acid episodes, and is also useful for diagnosing other conditions that mimic the GERD's clinical symptoms.

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The Second Canadian Gastroesophageal Reflux Disease Consensus: Moving Forward to New Concepts

Canadian Journal of Gastroenterology ◽

10.1155/1998/925346 ◽

1998 ◽

Vol 12 (8) ◽

pp. 551-556 ◽

Cited By ~ 24

Author(s):

ABR Thomson ◽

N Chiba ◽

D Armstrong ◽

G Tougas ◽

RH Hunt

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Severe Disease ◽

Initial Therapy ◽

Current Data ◽

Esophageal Disease ◽

Potential Cost ◽

Physician Visits ◽

First Line Therapy

Gastroesophageal reflux disease (GERD) is a disease with serious consequences that may result in significant impairment in quality of life and disease morbidity. Across all grades of severity of symptoms and severity of underlying esophageal disease, proton pump inhibitors (PPIs) provide therapeutic gains over prokinetics (PKs) or H2receptor antagonists (H2RAs). The potential cost effectiveness of using medications with higher acquisition costs that may lower health care costs overall is often disregarded when conducting cost comparisons with medications having lower 'up-front' costs. Limiting therapy to less effective agents condemns many patients to protracted suffering, repeated physician visits and needless reinvestigation of symptoms that could have been resolved by appropriate initial therapy. Based on current data, use of any classification of symptom severity as a basis for selecting one class of therapeutic agents over another for first line therapy (ie PKs, H2RAs for 'mild' GERD, versus a PPI for 'severe' disease) is unwarranted.

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Gastroesophageal Reflux Disease: Serious Illness Potential Often Misunderstood

ASHA Leader ◽

10.1044/leader.ftr1.11152006.6 ◽

2006 ◽

Vol 11 (15) ◽

pp. 6-21

Author(s):

Ellen N. Friedman

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Serious Illness

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Gastroesophageal Reflux Disease: A Gastroenterologist's Perspective

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd21.3.89 ◽

2011 ◽

Vol 21 (3) ◽

pp. 89-99

Author(s):

Michael F. Vaezi

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Best Practice ◽

Clinical Care ◽

Diagnostic Testing ◽

Diagnostic Tools ◽

Swallowing Function ◽

Atypical Symptoms

Gastroesophageal reflux disease (GERD) is a commonly diagnosed condition often associated with the typical symptoms of heartburn and regurgitation, although it may present with atypical symptoms such as chest pain, hoarseness, chronic cough, and asthma. In most cases, the patient's reduced quality of life drives clinical care and diagnostic testing. Because of its widespread impact on voice and swallowing function as well as its social implications, it is important that speech-language pathologists (SLPs) understand the nature of GERD and its consequences. The purpose of this article is to summarize the nature of GERD and GERD-related complications such as GERD-related peptic stricture, Barrett's esophagus and adenocarcinoma, and laryngeal manifestations of GERD from a gastroenterologist's perspective. It is critical that SLPs who work with a multidisciplinary team understand terminology, diagnostic tools, and treatment to ensure best practice.

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