Health-Related Quality of Life Issues in Gastroesophageal Reflux Disease

Jung Hwan Oh

doi:10.4166/kjg.2010.55.2.85

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Oh: Health-Related Quality of Life Issues in Gastroesophageal Reflux Disease

Review

Korean J Gastroenterol 2010;55(2):85-93.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.55.2.85

Health-Related Quality of Life Issues in Gastroesophageal Reflux Disease

Jung Hwan Oh, M.D.

Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea

Correspondence to: Jung Hwan Oh, M.D. Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, 620-56, Jeonnong 2-dong, Dongdaemun-gu, Seoul 130-709, Korea Tel: +82-2-958-2473, Fax: +82-2-968-7250 E-mail: ojh@catholic.ac.kr

Abstract

Several studies have reported significant Health-Related Quality of life (HRQOL) impairment in gastroesophageal reflux disease (GERD) patients compared with the general population. The evaluation of quality of life is important as a parameter for the treatment. Because GERD has diverse symptoms such as esophageal and extraesophageal syndromes, HRQOL of GERD should be determined by both disease and non-disease related factors. The purpose is to overview the HRQOL instruments used in the evaluation of GERD, published reports regarding HRQOL in GERD, and the effects of medical treatments on GERD.

Keywords: Gastroesophageal reflux disease, Quality of life

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Table 1.

Health Related Quality of Life (HRQOL) Instruments Used in Gastroesophageal Reflux Disease (GERD)

	Ref.	Domain addressed	No. items	Description	Recall period
Generic
SF-36	17	Physical function, role limitations-physical, bodily pain, vitality, general health perceptions, social functioning, role limitations-emotional, mental health	36	Score 0 (worst)- 100 (best)	Last 4 weeks (standard version), last week (acute version)
PGWB	18	Anxiety, depressed mood, positive well-being, self control, general health, vitality	22	Score 22-132 (higher score better)	Last 4 weeks
EQ-5D	19	Mobility, self-care, usual activities, pain/discomfort and anxiety/depression	5	Score 0 to 100 (best)	Last 12 months
WHOQOL- BREF	21	Physical health, psychological, social relationships, environment	26	5 response categories, Score 26 to 130 (best)	Last 2 weeks
Disease specific GI-specific
QOLRAD	27	Emotional, sleep, eating problems, physical/social, vitality	25	7-point Likert scale, 1 (worst) to 7 (best)	Previous week
PAGI-QOL	28	Daily activities, clothing, diet and food habits, relationship, psychological well-being and distress	30	6-point Likert scale	Last 2 weeks
GIQLI	29	Symptoms, physical, emotional and social dysfunction related to GI diseases or treatments	36	5-point Likert scale, 0 (worst) to 144 (best)	Previous 2 weeks
GERD-specific
GERD-HRQL	30	Severity of heartburn, conditions of heartburn, dysphagia, dynophagia, effects of medication, flatulence	10	6-point Likert scale, 45 (worst) to 0 (best)	-
HBQOL	31	Role physical, pain, sleep, diet, social, mental health	15	0 (worst)- 100 (best)	Previous week, past 30 days
WPAI-GERD	32	Absence from work, reduction in productivity and activites	-	Given in hours per day, and in percent reduction	-

-, no information provided; SF-36, the 36-Item Short-Form Health Survey; PGWB, Psychological General Well-Being index; EQ-5D, EuroQol-5 dimensions; QOLRAD, Quality of Life in Reflux and Dyspepsia; PAGI, Patient Assessment of upper Gastrointestinal disorders; GIQLI, Gastrointestinal Quality of Life Index; GERD-HRQL, Gastroesophageal Reflux Disease Health-Related Quality of Life; HBQOL, Heartburn-specific Quality of Life; WPAI, Work Productivity and Activity Impairment.

Table 2.

Published Reports Regarding Quality of Life in Gastroesophageal Reflux Disease (GERD)

First author	Published year	Study ref.	Country	Study sample	Subjects	Quality of life instrument	Conclusion
Wahlqvist	2001	38	Sweden	136	Working population	SF-36, QOLRAD, WPAI	Symptoms incur a large burden to the patient as well as a considerable cost to society due to absence from work, reduced productivity while working, and reductions of regular daily activities.
Kulig	2003	11	Germany, Austria and Switzerland	6,215	GERD patients (ProGERD study)	SF-36, QOLRAD	GERD causes a significant impairment in the QOL that can be attenuated or normalized within a time period as short as 2 weeks by treatment with esomeprazole.
Dean	2003	39	US	1,003 employed individuals	Subjects with chronic heartburn	WPAI	Reduced work productivity is seen in a large proportion of subjects on prescription medication for gastro-oesophageal reflux disease.
Ronkainen	2006	40	Sweden	999	General population (Kalixanda study)	SF-36	Most aspects of HRQOL were impaired in individuals with daily or weekly reflux symptoms.
Wiklund	2006	41	Sweden	1,476	General population	PGWB	Patients with esophagitis showed an impaired HRQOL that improved or normalized after treatment with pantoprazole.
Wahlqvist	2008	42	US	10,028 (Survey)	General population	WPAI, SF-8	Increasing severity and frequency of GERD symptoms is associated with lower HRQOL, lower work productivity and increased healthcare utilization.
Eslick	2009	43	Austrailia	78 subjects with weekly heartburn and/ or acid regurgitation of 1,000 residents	General population	SF-36	Increasing GERD symptom severity is associated with worse QOL scores, whereas GERD symptom frequency did not impact the QOL scores.
Nocon	2009	44	Germany, Austria and Switzerland	4,597	GERD patients (ProGERD study)	SF-36, QOLRAD	Achieving longterm, well-controlled HRQOL is possible in GERD patients under routine care with a PPI.
Ponce	2009	45	Spain	252	General population	SF-36, QOLRAD	In symptomatic GERD, HRQOL is very deteriorated. The factors that worsen the QOL are being female, increase in BMI, and nocturnal symptoms.
Hansen	2009	46	Denmark	6,781	General population	SF-36	Reflux symptoms are prevalent, long lasting, and associated with an impaired quality of life and substantial healthcare use.

SF-36, the 36-Item Short-Form Health Survey; QOL, quality of life; QOLRAD, Quality of Life in Reflux and Dyspepsia; WPAI, Work Productivity and Activity Impairment, HRQOL, health related quality of life; PGWB, Psychological General Well-Being index.

Table 3.

Published Reports on the Effects of Medical Treatment on Quality of Life in Gastroesophageal Reflux Disease (GERD)

Author	Published year	Study ref.	y Study sample	Therapy	Quality of life instrument	Conclusion
Kaplan-Machlis	2000	64	268 patients with GERD	Omeprazole vs. ranitidine	PGWB, SF-36	Ranitidine and omeprazole were both effective at improving heartburn symptoms
Kaspari	2001	65	215 patients with GERD persisting for ≥3 mo	Pantoprazole vs. ranitidine	SF-36, GIQLI	SF-36 and GIQLI domain scores improved from baseline in both treatment groups
Johanson	2002	66	2,449 mild esophagitis, open-label, multicenter study	Rabeprazole	SF-36	Community-based patients with erosive esophagitis reported significant improvements in all areas of HRQOL measured by the SF-36
Pare	2003	67	208 patients with heartbur prospective, randomized, double blind Canadian multicenter study	Pantoprazole vs. nizatidine n,	SF-36, SF-12	HRQOL improves more rapidly and to a greater degree following treatment with pantoprazole than nizatidine, pantoprazole instead of nizatidine as the initial therapy for patients with heartburn in a primary care practice setting
Ponce	2004	68	55 patients with GERD	Rabeprazole	SF-36	Normalization of HRQOL
Pace	2005	69	6,017 mild esophagitis, open-label, multicenter study	Esomeprazole	SF-36, QOLRAD	Esomeprazole therapy allows immediate relief in the acute phase of the disease.
de Souza Cury	2006	70	78 patients with GERD (sx, esophagitis)	Pantoprazole	SF-36, GERD score	Patients with esophagitis showed an impaired HRQOL that improved or normalized after treatment with pantoprazole.
Hansen	2006	71	2,156 patients with heartburn, prospective, randomised, open, parallel-group study	Esomeprazole continuously, on-demand or ranitidine	QOLRAD	Esomeprazole 20 mg once daily continuously and on-demand were more effective than ranitidine continuously for maintaining QOL.
Hongo	2008	72	2,320 patients with reflux esophagitis	Lansoprazole	SF-8, RE-specific HRQOL	HRQOL improved by treatment with lansoprazole.
Kinoshita	2009	73	8,757 patients with reflux esophagitis	Lansoprazole	SF-8, RE-specific HRQOL	Lifestyle modification may be clinically beneficial in terms of improving HRQOL in Japanese patients with RE who are receiving treatment with a PPI.

SF-36, the 36-Item Short-Form Health Survey; PGWB, Psychological General Well-Being index; GIQLI, Gastrointestinal Quality of Life Index; HRQOL, health related quality of life; QOLRAD, Quality of Life in Reflux and Dyspepsia; QOL, quality of life; RE, reflux esophagitis.

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