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Management of gastroesophageal reflux disease by primary care physicians and gastroenterologists: A prospective study of patients’ records - 12/12/08

Doi : 10.1016/j.gcb.2008.05.020 
J.-F. Bretagne a, , C. Honnorat b, B. Richard-Molard c, C. Soufflet d, P. Barthélemy d
a Service des maladies de l’appareil digestif, hôpital Pontchaillou, 2, rue Le-Guilloux, 35033 Rennes, France 
b Faculté de médecine, 2, avenue Léon-Bernard, 35043 Rennes, France 
c Clinique Saint-Martin, Allée des Tulipes, 33608 Pessac, France 
d Laboratoires AstraZeneca, 1, place Renault, 92844 Rueil-Malmaison, France 

Corresponding author.

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Summary

Background

We previously compared the perceptions and practices of primary care physicians (PCP) and gastroenterologists (GE) in the management of gastroesophageal reflux disease (GORD), but the data were only declarative statements.

Objective

The aim of the present study was to analyze the respective management of GORD by PCP and GE on the basis of patients’ records, and to look for any discrepancies between the declared and actual practices in both groups of physicians in the management of GORD.

Methods

A representative sample of French physicians was asked to enroll two consecutive patients with frequent and typical symptoms of GORD into a prospective observational survey.

Results

A total of 136 PCP and 91 GE participated in the survey and enrolled 271 and 182 patients, respectively, with frequent GORD symptoms (453 patients in total). Patients consulting GE were slightly younger, and had waited longer before arranging a consultation despite having symptom severity and impact on daily life similar to those visiting PCP. Most patients enrolled by GE had undergone upper GI endoscopy (95% versus 64% from PCP, P<0.01). In both groups of physicians, recourse to endoscopy for their patients was more frequent than they estimated. Prescription therapies for GORD were usually Proton Pump Inhibitors (PPI) in both groups of physicians and were in keeping with the declared findings.

Conclusions

Despite differences between patients’ characteristics, the management of frequent GORD was similar by both groups of physicians. The reasons why both groups of physicians underrated their actual recourse to endoscopy for their patients warrant further investigation.

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Résumé

Objectifs

Dans une étude précédente, nous avions déjà comparé la perception et les pratiques des médecins généralistes (MG) et des gastro-entérologues (GE) dans la prise en charge du reflux gastro-œsophagien (RGO), mais il s’agissait des données déclaratives. Le but de cette étude a été, à travers l’analyse de dossiers patients, de rechercher des différences de pratiques entre les deux groupes de praticiens.

Malades et méthodes

Il était demandé à un échantillon représentatif de médecins français d’inclure deux patients consécutifs ayant des symptômes fréquents et typiques de RGO dans une cohorte prospective observationnelle. Au total, 136 MG et 91 GE ont participé à l’étude et ont inclus un total de 453 cas, respectivement 271 et 182 cas.

Résultats

Les patients consultant les GE étaient un peu plus jeunes, et ils avaient attendu plus longtemps avant de consulter malgré une sévérité symptomatique et un impact sur la qualité de vie similaires à ceux consultant les MG. La plupart des patients inclus par les GE avaient eu une endoscopie digestive haute (95 % versus 64 % pour les MG, p<0,001). Pour les deux groupes de praticiens, le recours à l’endoscopie chez leurs patients était plus fréquent qu’ils ne l’imaginaient. Pour les deux groupes de praticiens, les traitements les plus prescrits étaient les inhibiteurs de la pompe à protons (IPP) et cela était en accord avec les données déclaratives.

Conclusion

Malgré des différences concernant les caractéristiques de leurs patients, les MG et les GE avaient une même approche du RGO. Les raisons pour lesquelles le recours à l’endoscopie haute est globalement sous-estimé mériteraient d’être élucidées.

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Vol 32 - N° 12

P. 995-1000 - Dicembre 2008 Ritorno al numero
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