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Abstract
Background/Aims
Gastroesophageal reflux disease (GERD) is a chronic condition and accompanied by frequent relapses. We aimed to evaluate the clinical practice patterns of gastroenterologists for initial and maintenance therapy of GERD in Korea.
Methods
We administered a nationwide, multicenter, and questionnaire-based online survey between December 2007 and January 2008. The questionnaire consisted of 15 questions about prescribing patterns of initial and maintenance therapy for GERD.
Results
A total of 371 gastroenterologists participated in the survey with the response rate of 77%. For mild cases of GERD, the most common choice of initial therapy was full dose proton-pump inhibitors (PPIs) (59%), followed by half dose PPIs (20%), and H2 receptor antagonists (4%). For severe cases, full dose PPIs were prescribed in 99%. Almost all gastroenterologists agreed to the need for maintenance therapy. For both mild (95%) and severe (99%) cases of GERD, gastroenterologists preferred the use of PPI-based maintenance regimen. The preferred maintenance strategy for GERD was continuous therapy in erosive esophagitis (67%), and on-demand therapy in non-erosive reflux disease (68%). The overall duration of the therapy (initial＋maintenance) was 7.7±5.1 wk in mild cases and 15.0±9.4 wk in severe cases. The duration of maintenance therapy was affected by symptom severity, followed by symptom frequency and endoscopic finding.
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Fig. 1.
Medication of choice for maintenance therapy in mild and severe gastroesophageal reflux disease. GERD, gastroesophageal reflux disease; PPI, proton pump inhibitor; H2RA, H2 receptor antagonist.
Fig. 2.
Maintenance strategy of choice for mild and severe gastroesophageal reflux disease. EE, erosive esophagitis; NERD, non-erosive reflux disease.
Fig. 3.
Total duration of treatment for mild and severe gastroesophageal reflux disease. GERD, gastroesophageal reflux disease.
Table 1.
Demographic Information of 371 Respondent Gastroenterologists
| No. | % | |
|---|---|---|
| Mean age, year (range) | 42.4±4.8 | (32-68) |
| Sex (male:female) | 6:1 | 1 |
| Location of the hospitals | ||
| Seoul | 82 | 22 |
| Metropolitan city∗ | 79 | 21 |
| Gyeonggi province | 57 | 15 |
| Chungcheong province | 52 | 14 |
| Gyeongsang province | 75 | 20 |
| Jeolla province | 24 | 7 |
| Jeju province | 2 | 1 |
| Length of practice (year) | ||
| 1-4 | 95 | 26 |
| 5-9 | 164 | 44 |
| 10-14 | 67 | 18 |
| ≥15 | 45 | 12 |
| Affiliation | ||
| University or general hospital | 232 | 63 |
| Smaller hospital | 139 | 38 |
Table 2.
Proportions of Several Factors Influencing the Duration of Treatment in Gastroesophageal Reflux Disease∗
| 1st | 2nd | 3rd | 1st-3rd | |
|---|---|---|---|---|
| (%) | (%) | (%) | (%)† | |
| Symptom severity | 72.9 | 17.6 | 6.2 | 32.3 |
| Symptom frequency | 5.9 | 40.0 | 17.9 | 21.3 |
| Presence or absence of lesion | 5.0 | 7.9 | 12.9 | 8.6 |
| Severity of lesion | 11.8 | 25.3 | 26.5 | 21.2 |
| Patient's economy | 0 | 1.8 | 9.1 | 3.6 |
| Patient's residence | 0 | 0.3 | 2.4 | 0.9 |
| Insurance policy of the government | 0 | 4.4 | 17.1 | 7.2 |
| Insurance policy of the hospital | 2.9 | 1.8 | 2.9 | 2.5 |
| Prescription pattern of doctor | 0.6 | 0.6 | 3.8 | 1.7 |
| Clinical condition of doctor | 0.9 | 0.3 | 1.2 | 0.8 |
| Total | 100 | 100 | 100 | 100 |
5. 초 치료에 주로 사용하는 방법은 무엇입니까?
| 경증 위식도 역류질환 | 중증 위식도 역류질환 | |
|---|---|---|
| 1) Full-dose PPI | ||
| 2) Half-dose PPI | ||
| 3) H2RA | ||
| 4) Prokinetics | ||
| 5) Antacid | ||
| 6) Life modification | ||
| 7) Combination |
6. 초 치료 기간은 어느 정도인지 환자의 비율을 적어 주 십시오.
| 경증 위식도 역류질환 중 | 증 위식도 역류질환 | |
|---|---|---|
| 1) 4주 이내 | % | % |
| 2) 4-8주 | % | % |
| 3) 8주 이상 | % | % |
7. 위식도 역류질환의 유지치료에 주로 사용하는 투여법은 무엇입니까?
| 경증 위식도 역류질환 | 중증 위식도 역류질환 | |
|---|---|---|
| 1) Continuous therapy | ||
| 2) On-demand therapy | ||
| 3) Intermittent therapy | ||
| 4) 기타 |
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