Gastro-oesophageal reflux disease in primary care in Europe: Clinical presentation and endoscopic findings

Abstract

Objective: To determine the characteristics of patients presenting in primary care with gastroesophageal reflux disease (GORD), in terms of clinical features and endoscopic diagnosis. Design: European multi-national, multi-centre, non-therapeutic study, in which detailed documentation of presenting symptoms was followed within seven days by upper gastrointestinal endoscopy. Setting: 52 primary care centres in United Kingdom, Germany and Ireland. Subjects: 806 patients aged over 18 years presenting with symptoms which, in the opinion of the primary care physician, are suggestive of GORD. Main outcome measures: Presenting reflux-symptom profile, reflux-symptom history, endoscopic findings. Results: The majority of patients (66.7%) reported experiencing symptoms daily and almost half (49.4%) experienced symptoms both during the day and at night. Posture and stress/anxiety were reported by patients as the main factors aggravating their symptoms. Most patients rated their symptoms as moderate to severe (90.4%). The commonest symptoms volunteered by patients on presentation were retrosternal burning (61%) and epigastric pain (33.9%). The most frequent symptoms elicited on questioning were retrosternal burning (86%), epigastric burning (63%) and retrosternal pain (60%). On endoscopic examination, 41.4% of patients were found to have mild to moderate oesophagitis and 4.1% of patients had severe erosive oesophagitis or ulceration. Other endoscopic findings included gastric ulcer (2.8%), duodenal ulcer (11%) and oesophageal carcinoma (0.4%). Attempts to characterise patients with more severe pathology proved inconclusive. Conclusion: This study has provided a description of the clinical and endoscopic features of patients presenting in primary care with symptoms of GORD. The findings lend strong support for the view that initial treatment based on clinical diagnosis is an appropriate strategy to adopt in primary care, but persistent or atypical symptoms warrant prompt investigation.