PECULIARITIES OF QUALITY OF LIFE IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE.

Many studies showed, that quality of life (QL ) is affected in case of gastroesophageal reflux disease (GERD). Numerous questionnaires with a wide variety of characteristics have been developed for the assessment of GERD. The current study aimed to determine the QL changes of patients with GERD. The sample consisted of 100 patients with GERD. We also formed control group, which consist of 50 practical healthy patients (without GERD). In case group we formed two subgroups- GERD with Esophagitis and GERD without Esophagitis. For QL measure we used SF-36 questionnaire. In case group 58 patients were male and 42 were female. GERD without Esophagitis subgroup included 71 cases, 41 of which were diagnosed in men and 30 in women. The mean age of this subgroup was 35.3±5.2 years. The second clinical subgroup is gastroesophageal reflux, with eosophthalic patients, which consisted of 29 cases. 17 patients in this subgroup were male and 12 female. The mean age of this subgroup was 35,4±5,3 years. The most affected subscales of patients with GERD were "Role physical functioning", "General health", "Role emotional functioning" comparing with control group according SF-36 questionnaire. In the case of GERD without an esophagus, the most affected were "Role physical functioning" and "Role emotional functioning" subscales. Regardless of the type of subgroup, QL "Bodily pain" and "General health" subscal's scores were lowIn case group patients, who have BMI>25 kg/m2 have lower scores of QL compared to the group GERD BMI<25kg/m2.

[Quality of life of patients with complicated reflux-esophagitis followed antireflux surgery]. / Kachestvo zhizni bol'nykh, operirovannykh po povodu refliuks-ézofagita i ego oslozhnenii.

AIM: To analyze quality of life of patients with complicated reflux-esophagitis followed antireflux surgery. MATERIAL AND METHODS: The trial enrolled 200 patients who underwent surgical treatment at the Burdenko Faculty Surgery Clinic of Sechenov First Moscow State Medical University for complicated reflux esophagitis from 2008 to 2015. Inclusion criteria were long-standing reflux esophagitis irresistible to conservative treatment, hiatal hernia with shortening of the esophagus and/or peptic stricture and/or Barrett's esophagus. Patients were divided into 2 groups according to the degree of esophagus shortening: group I - 98 patients with esophagus shortening degree I; group II - 102 patients with shortening grade II. Men/women ratio was 87(43.5%)/113(56.5%). Mean age was 56.0±13.9 years (16-83 years). We performed fundoplication in A.F. Chernousov modification in the first group and modified valvular gastroplication in the second group. All patients underwent survey within 6 months - 10 years after surgery to assess long-term outcomes. X-ray examination, upper GI endoscopy, standard laboratory tests were performed with pH-impedance and computed tomography if it was necessary. Quality of life was estimated by RAND SF-36 and GSRS (Gastrointestinal Symptom Rating Scale) questionnaires. RESULTS: SF-36 questionnaire revealed postoperative changes of physical, psychological and social values and was able to compare them with those in general population. Postoperative overall health was significantly higher in both groups compared with preoperative level and comparable with general population. GSRS questionnaire have also revealed positive changes. Overall postoperative GSRS score was 1.6±0.5 and 1.6±0.6 points in groups I and II respectively that corresponds to minor concern after surgery.

Heartburn and regurgitation have different impacts on life quality of patients with gastroesophageal reflux disease.

AIM: To investigate the impact of heartburn and regurgitation on the quality of life among patients with gastroesophageal reflux disease (GERD). METHODS: Data from patients with GERD, who were diagnosed according to the Montreal definition, were collected between January 2009 and July 2010. The enrolled patients were assigned to a heartburn or a regurgitation group, and further assigned to an erosive esophagitis (EE) or a non-erosive reflux disease (NERD) subgroup, depending on the predominant symptoms and endoscopic findings, respectively. The general demographic data, the scores of the modified Chinese version of the GERDQ and the Short-form 36 (SF-36) questionnaire scores of these groups of patients were compared. RESULTS: About 108 patients were classified in the heartburn group and 124 in the regurgitation group. The basic characteristics of the two groups were similar, except for male predominance in the regurgitation group. Patients in the heartburn group had more sleep interruptions (22.3% daily vs 4.8% daily, P = 0.021), more eating or drinking problems (27.8% daily vs 9.7% daily, P = 0.008), more work interferences (11.2% daily vs none, P = 0.011), and lower SF-36 scores (57.68 vs 64.69, P = 0.042), than patients in the regurgitation group did. Individuals with NERD in the regurgitation group had more impaired daily activities than those with EE did. CONCLUSION: GERD patients with heartburn or regurgitation predominant had similar demographics, but those with heartburn predominant had more severely impaired daily activities and lower general health scores. The NERD cases had more severely impaired daily activity and lower scores than the EE ones did.

[Clinical, endoscopic and morphological manifestations of oesophageal lesion in systemic scleroderma].

UNLABELLED: Oesophageal lesion is the commonest visceral manifestation of systemic scleroderma (SSD) affecting the quality of life and fraught with serious complications. The aim of this study was to evaluate clinical, endoscopic andmorphological manifestations of oesophageal lesion in systemic scleroderma and its relationships with other clinical symptoms and pharmacotherapy of the disease. MATERIALS AND METHODS: 479 patients with SSD (93.7% women, 6.3% men, mean age 48.7 +/- 19.2 yr). All of them underwent EGDS in 2005-2010. 123 patients were examined for the detection of Barrett's oesophagus (BO), total screening regardless of complaints was conducted in 2010. Control group included 1018 age and sex-matched patients with RA who underwent EGDS in 2008-2009. RESULTS: Oesophageal lesions occurred much more frequently in SSD than in RA. Oesophageal symptoms were documented in 70.0 and 29.9% cases, non-erosive oesopahgitis in 28.8 and 1.5%, erosive esophagitis in 22.5 and 2.2% ulcers in 0.8 and 0% (p < 0.001). BO manifested as intestinal metaplasia (histological study of mucosal biopsy) was found in 30 SSD patients (4.2%). Screening revealed BO in 8.9% of the patients. The development of erosive oesophagitis was unrelated to the age of the patients, duration of the disease and its form (localized or diffusive), lung pathology or Sjogren's syndrome. Cytotoxic medicines significantly increased the frequency of erosive oesophagitis, it tended to increase under effect of NSAID and low doses of aspirin. Long-term intake of PPI did not reduce the risk of oesophagitis and BO. CONCLUSION: Half of the patients with SSD have oesophagitis. Over 20% of them suffer its complications (erosion and ulcers) and 9% have BO. All such patients need endoscopic study ofoesophagus regardless of clinical symptoms.

[The role of psycho-autonomic status and the serotonergic system in patients with gastroesophageal reflux disease].

OBJECTIVE: Identify the differences of the autonomic nervous system (ANS), serotonin levels, cognitive, behavioral and emotsinalnoy areas in groups of patients with reflux esophagitis (RE) and non-erosive reflux disease (NERD) and assess the impact on the disease. MATERIALS AND METHODS: The study included 71 patients rith gastroesophageal reflux disease (GERD), including 29 patients with ER, 42--NERD. Diagnosis was based on anamnesis, clinical research, fibrogastrocopy, pH-metry. Tested with a scale situational and personal anxiety Spielberg Hanina, diagnostic techniques and forms of aggression indicators A. Bass and A. Dark, the Toronto aleksitimicheskoy scale method for investigating the level of subjective control, clinical questionnaire for the identification and evaluation of neurotic states, personality questionnaire Bekhterevsky Institute, cardiointervalography, orthoklinostatik and cold test, determined the level of serotonin in the blood. RESULTS: Compared with the group of patients suffering from ER patients with NERD determined by the displacement in the direction of internality measure locus of control personality, and patients with ER, in contrast, had lower locus of control personality, a high level of situational anxiety, irritability, anxiety type of attitude to the situation of the disease associated with impaired autonomic software ANS activity. CONCLUSION: Patients with ER are more pronounced changes in cognitive-emotional sphere may have an impact on the course of disease and requiring psychological, medical correction.

Psychosocial factors and their association with reflux oesophagitis, Barrett's oesophagus and oesophageal adenocarcinoma.

AIM: To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma (OAC), as well as the reflux-mediated precursor pathway. METHODS: An all-Ireland population-based case-control study recruited 230 reflux oesophagitis (RO), 224 Barrett's oesophagus (BO) and 227 OAC patients and 260 controls. Each case/control group completed measures of stress, depression, self-efficacy, self-esteem, repression and social support. A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders. RESULTS: Compared to controls, OAC patients were almost half as likely to report high stress levels over their lifetime (P = 0.010, OR 0.51; 95%CI: 0.29-0.90) and 36% less likely to report having experienced depression (OR 0.64; 95%CI: 0.42-0.98). RO patients reported significantly higher stress than controls particularly during middle- and senior-years (P for trends < 0.001). RO patients were 37% less likely to report having been highly emotionally repressed (OR 0.63; 95%CI: 0.41-0.95). All case groups (OAC, RO and BO) were more likely than controls to report having had substantial amounts of social support (OR 2.84; 95%CI: 1.63-4.97; OR 1.97; 95%CI: 1.13-3.44 and OR 1.83; 95%CI: 1.03-3.24, respectively). CONCLUSION: The improved psychological profile of OAC patients may be explained by response shift. The role of psychological factors in the development of OAC requires further investigation.

The association between reflux esophagitis and psychosocial stress.

BACKGROUND: The prevalence of reflux esophagitis is increasing in Korea. Reflux esophagitis aggravates the stress and fatigue level of daily life, but less is known about the association with stress and fatigue, which could be bi-directional. AIM: To evaluate the impact of reflux esophagitis on stress and fatigue and to compare the stress level of people with reflux esophagitis with that of controls with peptic ulcer disease and healthy controls. METHODS: Among a total of 9,033 subjects who underwent a comprehensive medical check-up including upper endoscopy, 6,834 subjects (75.7 %) were enrolled. Stress and fatigue scores were measured by a validated Korean version of the Brief Encounter Psychosocial Instrument and the Fatigue Severity Scale. RESULTS: Among 6,834 subjects, 13.2 % were in the high-stress group, and reflux esophagitis was found in 6.0 %. After adjustment for confounders, reflux esophagitis was significantly associated with high stress (odds ratio 1.94, 95 % confidence interval 1.25-3.02). Subjects with reflux esophagitis had significantly higher BEPSI-K scores compared with healthy controls (p = 0.027); and however, there was no significant difference in BEPSI-K scores between reflux esophagitis group and peptic ulcer disease controls. Fatigue severity scale was highly correlated with BEPSI-K (p < 0.001); however, there was no significant difference in fatigue severity scale level between the reflux esophagitis group and controls. The severity of reflux esophagitis was significantly correlated with BEPSI-K score (p = 0.008). CONCLUSIONS: Reflux esophagitis is significantly associated with psychosocial stress, and the severity of reflux esophagitis correlates with the degree of stress.

Anxiety and depression in various functional gastrointestinal disorders: do differences exist?

OBJECTIVE: To examine the differences in the prevalence and severity of anxiety and depression in patients with functional dyspepsia (FD), nonerosive reflux disease (NERD), irritable bowel syndrome (IBS) and healthy controls. METHODS: Consecutive patients undergoing an index endoscopic examination for various symptoms were interviewed. All the three functional gastrointestinal disorders (FGIDs) were diagnosed according to the Rome III criteria. Anxiety and depression were diagnosed using a locally validated version of the hospital anxiety and depression scale. RESULTS: A total of 248 patients were recruited (62 in FD, NERD, IBS and control groups each) with no differences in the basic characteristics. There was a higher prevalence of anxiety and depression in FD, NERD and IBS groups than that in the control group (43.5%, 45.2% and 67.7% vs 14.5%, P<0.001; and 22.6%, 33.9% and 38.7% vs 6.5%, P<0.0001). Using the cut-off score (>8) for anxiety or depression, IBS patients had a higher rate of anxiety than FD (P=0.01) and NERD (P=0.02), while no significant differences in depression rates were observed among all three groups. CONCLUSION: [corrected] Anxiety is more common in patients with IBS than in those with FD and NERD, indicating a possible causal link in the former.

Effects of omeprazole on symptoms and quality of life in Japanese patients with reflux esophagitis: final results of OMAREE, a large-scale clinical experience investigation.

BACKGROUND: For patients with reflux esophagitis (RE), endoscopic findings alone (without the frequency and severity of symptoms) may not fully reflect the associated impact on health-related quality of life (QOL). There is not enough data about symptoms and QOL of Japanese patients with RE. The present study therefore investigated the epidemiological characteristics of such patients, and evaluated the efficacy and safety of omeprazole (and other gastrointestinal drugs, except proton pump inhibitors [PPIs]) in terms of improving patients' symptoms and QOL. METHODS: In a large-scale, specific clinical experience investigation of Japanese patients with RE, epidemiological characteristics, QOL and symptoms of the disease in relation to treatment with omeprazole and other gastrointestinal drugs, except PPIs, and safety data of omeprazole were collected. The Quality Of Life in Reflux and Dyspepsia questionnaire (QOLRAD) was used for QOL assessment. RESULTS: 9967 patients were included in the analysis (omeprazole: 7888). At baseline, 75.2% of patients had three or more upper gastrointestinal symptoms, and 31.5% of patients had six or more upper gastrointestinal symptoms. The overall mean QOLRAD score at baseline was 5.14 (the best score is 7). In the omeprazole group, the rate of satisfactory improvement in subjective symptoms was 61.7% and 81.8% at Weeks 4 and 8, respectively, and these were both significantly higher than those of patients treated with other drugs. In both the omeprazole group and the other drugs group, the QOLRAD score at Week 4 improved significantly from baseline, and the degree of improvement was significantly greater in the omeprazole group than in the other drugs group. The favourable tolerability profile of omeprazole was confirmed. CONCLUSION: In a large-scale survey, omeprazole improved symptoms and QOL more effectively in Japanese patients with RE than other investigated drugs, and had a good tolerability profile. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00859287.

[The quality of life dynamics in patients with gastroesophageal reflux disease during rabeprazol therapy].

The present article represents findings of quality of life index dynamics for 100 patients with gastroesophageal reflux disease under pressure of proton pump inhibitor therapy. The degree of clinical evidence was measured by Likert scale, quality of life appraisal was made on the bases of SF-36, GSRS checklists, psychoemotional component of patients' health was analyzed with the help of the V.M. Bekhterev Institute personal enquirer. Treatment with Rabeprazole helps efficiently jugulate reflux disease symptoms and accurately improve quality of life index.

Characteristics affecting health-related quality of life (HRQOL) in Japanese patients with reflux oesophagitis and the effect of lansoprazole on HRQOL.

OBJECTIVES: A survey of health-related quality of life (HRQOL) in the Japanese general population has suggested that HRQOL is affected by sex and age. We investigated whether there is any effect of baseline patients' characteristics on HRQOL of patients with reflux oesophagitis (RE), and its changes with lansoprazole (LPZ) treatment. RESEARCH DESIGN AND METHODS: This was a post hoc analysis of an open-label, multicentre, post-marketing, observational study which investigated the effect of LPZ (15 or 30 mg/day for 8 weeks) on HRQOL in patients with RE. At baseline, and after 4 and 8 weeks of treatment, HRQOL was assessed using a Japanese version of the 8-item Short-Form Health Survey (SF-8) and a newly-developed RE-specific questionnaire (RESQ). Stratified analysis of changes in HRQOL scores according to baseline patient characteristics such as sex, age and baseline severity of typical RE symptoms was performed. RESULTS: A total of 8,757 patients were included in the efficacy analysis. At baseline, physical component summary scores from the SF-8 were lower in older patients (>/=60 years) than in younger patients (<60 years), and mental component summary scores were lower in younger patients than in older patients. These scores significantly improved after LPZ treatment regardless of sex and age. HRQOL scores were lower in patients with more severe typical RE symptoms at baseline. After LPZ treatment, HRQOL scores significantly improved to similar levels irrespective of the severity of the typical RE symptom at baseline. CONCLUSIONS: This post hoc analysis suggests that sex, age and severity of typical RE symptoms affect HRQOL in patients with RE in Japan, and such factors do not affect the improvement of HRQOL with LPZ treatment. The present study suggests a positive impact of LPZ; however, it is difficult to estimate the degree of improvement in HRQOL that may have arisen from symptomatic relief as part of the natural history of the disease from the study. Our results may overestimate the efficacy of LPZ. Further well-controlled clinical studies are needed to confirm the efficacy of LPZ on HRQOL in patients with RE.

The impact of lifestyle modification on the health-related quality of life of patients with reflux esophagitis receiving treatment with a proton pump inhibitor.

OBJECTIVES: Although lifestyle modification involving diet, exercise, cessation of smoking, etc. is generally advised for patients with reflux esophagitis (RE), few data that show its clinical benefits are available. We analyzed whether lifestyle modification improves health-related quality of life (HRQOL) in Japanese patients with RE receiving the proton pump inhibitor (PPI) lansoprazole as a post hoc analysis of an observational study that investigated the effect of lansoprazole on HRQOL. METHODS: Patients with RE received lansoprazole for 8 weeks. HRQOL was assessed using the 8-Item Short-Form Health Survey (SF-8) and RE-specific HRQOL questionnaires at baseline and after 4 and 8 weeks of treatment. Physical and mental component summaries (PCS, MCS) and RE-specific summary (RES) scores were calculated. RESULTS: Of the 8,757 patients analyzed, 40.8% were advised regarding new lifestyle at the start of lansoprazole treatment (Group A), 33.3% were advised to continue the lifestyle as advised previously (Group B), and 25.9% did not receive any advice (Group C). The change in PCS from baseline at week 8 for Group A was 5.7 +/- 8.1, and this was significantly greater (P < 0.001) than the increases achieved in Groups B (4.3 +/- 7.5) and C (4.0 +/- 7.6). The changes in MCS and RES were also significantly greater in Group A than in the other groups. The changes in HRQOL scores from baseline were significantly greater in Group A than in the other groups, irrespective of baseline patient characteristics. CONCLUSIONS: Lifestyle modification may be clinically beneficial in terms of improving HRQOL in Japanese patients with RE who are receiving treatment with a PPI.

[Financial restrictions in health care systems could affect treatment quality of GERD-patients]. / Wachsender Kostendruck im Gesundheitswesen kann zu einer Beeinträchtigung der Behandlungsqualität bei Refluxpatienten führen.

AIMS: To directly compare the efficacy and safety of pantoprazole 40 mg VS. omeprazole 20 mg in patients with gastroesophageal reflux disease (GERD). MATERIAL AND METHODS: 915 Patients suffering from symptomatic GERD B-D (Los Angeles classification) were included in a double-blind randomized multicenter clinical trial and treated with either pantoprazole 40 mg od or omeprazole 20 mg od for six weeks. Primary efficacy criterion was the first time to reach normal symptoms as assessed by the questionnaire ReQuest-GI. RESULTS: Compared to omeprazole 20 mg, pantoprazole 40 mg achieved a significantly faster rate of symptom relief (p = 0.0298). Thus, as assessed with the ReQuest questionnaire, patients treated with pantoprazole 40 mg experienced relief from the 7 leading GERD symptoms 2 days earlier than those treated with omeprazole 20 mg. Long-lasting sustained relief from symptoms was also achieved earlier with pantoprazole than with omeprazole; in patients treated with pantoprazole, the daily symptom load was lower than in those treated with omeprazole. After 6 weeks of treatment, over 90 percent of patients were free from symptoms in both treatment groups (93.7 % in the pantoprazole, vs. 91.8 % in the omeprazole group, PP). Both medications were well tolerated. CONCLUSIONS: GERD patients treated with pantoprazole 40 mg experience a significantly faster relief from their leading symptoms than those treated with omeprazole 20 mg.

[Anxiety and depression related to the symptoms of gastroesophageal reflux disease].

OBJECTIVE: To compare the differences in the psychological scale scoring among different subgroups reflux esophagitis (RE) and non-erosive reflux disease (NERD) and to explore the influence of mental factors on the pathogenesis of RE and NERD. METHODS: Two hundred and six patients with typical heartburn and acid regurgitation underwent endoscopy and esophageal pH monitoring and then were divided into 4 groups: RE+ group (n = 35, 24.3%) with RE and positive pH monitoring results, RH- group (n = 15, 30.0%) with RE and negative pH monitoring results, NERD+ group (n = 77, 40%), with NERD and positive pH monitoring results, and NERD- group (n = 79, 50.6%) with NERD and negative pH monitoring results that was re-divided into 2 subgroups according to the symptom index (SI): NERD-SI+ group (n = 18, 22.8%) with positive symptom index and NERD-SI- group (n = 61, 77.2%) with negative SI. The demographic data and body mass index (BMI) were investigated. The psychological questionnaires: Symptom Checklist 90 (SCL-90), and Hospital Anxiety and Depression Scale (HAD) were used. RESULTS: (1) Male patients were dominant in the RE group and RE+ subgroup, while female patients were dominant in the NERD group and NERD+ subgroup. The values of BMI of the RE group and RE+ subgroup were significantly higher than those of the NERD group and NERD+ subgroup. (2) The abnormal pH monitoring rate of the RE group was 70.0%, significantly higher than that of the NERD group (49.4%). The average DeMeester's score of the RE group was 39.3 (96.5), significantly higher than that of the NERD group 13.8 (33.6). The average DeMeester's score of the RE+ group was 68.1 (95.2), significantly higher than that of the NERD+ group 40.1 (64.4). (3) 44.6% (29/65) of the patients presented depression and 36.9% (24/65) had anxiety, most of them were in mild or moderate degree. The scores of most items of each mental scale were significantly higher in the NERD- patients than in the NERD+ patients, especially in the NERD-SI- subgroup. CONCLUSION: The symptoms of RE+ and NERD+ patients are associated with esophageal acid exposure and the acid reflux in the RE patients is much severer than that in the NERD patients. Anxiety and depression are related to the symptoms of patients without objective evidence of esophageal mucosal injury and acid reflux (NERD-), especially in the symptom index negative subgroup. Visceral hypersensitivity and stress play an important role in the pathogenesis of gastroesophageal reflux.

Intra-oesophageal distribution and perception of acid reflux in patients with non-erosive gastro-oesophageal reflux disease.

BACKGROUND: The majority of patients with gastro-oesophageal reflux disease do not present with erosive oesophagitis and make up a heterogeneous group. Patients with non-erosive gastro-oesophageal reflux disease are less responsive than patients with oesophagitis to acid-suppressive therapy. AIM: To assess the role of acid reflux in gastro-oesophageal reflux disease symptoms. METHODS: The spatio-temporal characteristics of reflux events were analysed and related to reflux perception in 45 patients with non-erosive gastro-oesophageal reflux disease and 20 patients with erosive oesophagitis. RESULTS: Compared with healthy controls, all patients showed a higher intra-oesophageal proximal spread of acid, which was prominent in patients with non-erosive gastro-oesophageal reflux disease (> 50% of events lasting for 1-2 min). Irrespective of mucosal injury, the risk of reflux perception was very high when acid reached proximal sensors (odds ratio, 7.6; 95% confidence interval, 4.6-12.5), being maximal in patients with non-erosive gastro-oesophageal reflux disease with normal acid exposure time (odds ratio, 11; 95% confidence interval, 5.2-22.3). CONCLUSIONS: Patients with non-erosive gastro-oesophageal reflux disease are characterized by a significantly higher proportion of proximal acid refluxes and a higher sensitivity to short-lasting refluxes when compared with patients with oesophagitis. The highest proximal acid exposure and highest perception occurred in patients with non-erosive gastro-oesophageal reflux disease presenting with a normal pH-metric profile. The assessment of acid distribution and its perception in the oesophageal body can better identify reflux patients who should benefit from acid-suppressive treatment.

Reductions in symptom distress reported by patients with moderately severe, nonerosive gastroesophageal reflux disease treated with rabeprazole.

Gastroesophageal reflux disease (GERD) is characterized by heartburn and related symptoms that are distressing to patients and interfere with everyday functioning and well-being. A measure of symptom distress, the GERD Symptom Assessment Scale (GSAS), was included in two randomized, placebo-controlled trials of rabeprazole among patients with nonerosive GERD. The age (mean +/- SD) of the 223 patients was 43.5 +/- 11.9 years, and most were female (67%) and Caucasian (78%). Significantly greater reductions in symptom distress were observed among patients receiving rabeprazole 20 mg daily for 4 weeks relative to those receiving placebo (-0.62 vs -0.36, P < 0.0001). The magnitude of this treatment difference was comparable to the differences observed between levels of overall symptom improvement on the patient global rating (0.2 and 0.3 points; P < 0.0001). In conclusion, reducing symptom distress is an important goal of therapeutic interventions for GERD. Rabeprazole significantly reduced the distress associated with a broad range of GERD symptoms, and the magnitude of this effect was meaningful to patients.

[Psycho-physiological aspects of gastroesophageal reflux disease]. / Psychophysiologische Aspekte der gastroösophagealen Refluxkrankheit.

It is well known that there is an interaction between physiological and psychological aspects of gastrointestinal diseases, also in esophageal symptoms. Based on this bio-psycho-social interaction, several multidisciplinary concepts of interventions in gastrointestinal disorders have been evaluated. The role of psychological factors in gastroesophageal reflux disease (GERD) is really unknown. The present article reviews the basic pathophysiological factors of GERD including psycho-physiological aspects and presents potential concepts of multidisciplinary GERD treatment.

On demand therapy of reflux oesophagitis--a prospective study of symptoms, patient satisfaction and quality of life.

BACKGROUND: In patients with low-grade reflux oesophagitis adequate symptom control is the aim of treatment. Effervescent tablets alleviate heartburn more rapidly than ordinary tablets. AIM: To investigate symptom control, patient satisfaction, health-related quality of life and disease progress when ranitidine 150 mg effervescent tablets were offered as on demand treatment. We also wanted to investigate whether any biological or psycho-social factor could predict patient satisfaction. METHOD: Consecutive patients with endoscopically verified reflux oesophagitis grade I-II were followed up for 12 months. 24 h pH-metry, disease history, symptoms and several psycho-social factors were registered at baseline and 12 months follow-up. RESULTS: Eighty-one patients were included. Mean age was 50.7 years (range 21-82), 63% were men. Mean tablet consumption was 1.21 per day (range 7-1016 tablets/year). At the 1-year follow-up discomfort resulting from reflux symptoms was significantly reduced (P<0.001), and the patients' social and vocational life improved. Eighty-four percentage of the patients were satisfied with the treatment. 24 h pH-metry or number of reflux episodes did not change. We did not find any factors able to predict patient satisfaction. CONCLUSIONS: On demand therapy with ranitidine effervescent tablets was well accepted by the majority of patients with reflux oesophagitis grade I. Even though the number of reflux episodes did not change, the patients experienced less discomfort due to reflux symptoms, and their social and vocational life was better. There was no significant progression of the disorder during the 1-year follow-up. No predictive factor for patient satisfaction was found.

The illness behavior of patients with gastroesophageal reflux disease with and without endoscopic esophagitis.

The aim of this study was to determine if patients who experience heartburn but have no objective evidence of gastroesophageal reflux disease are responding appropriately to their symptoms. One hundred and forty patients who had been referred for investigations of heartburn (75 males, 65 females, mean age 48 years) answered an Illness Behavior Questionnaire. All patients underwent pH monitoring tests, and endoscopy results were obtained for 119 patients. There was objective evidence of reflux disease on endoscopy or pH monitoring in 105 patients and no objective evidence of reflux in 35 patients. Sixty-six patients were endoscopy-'positive' while 53 patients were endoscopy-'negative'. The Illness Behavior Questionnaires for the four groups were analysed for seven scales of illness behavior and these were compared with reference populations. Patients with heartburn but no objective reflux were similar to those with heartburn and objective reflux on all scales of the Illness Behavior Questionnaire. The reflux group without endoscopic esophagitis also responded to their symptoms in the same way as those with endoscopic esophagitis. It is concluded that a patient's perception of symptoms in gastroesophageal reflux is probably not related to the degree of esophageal mucosal damage.

Valuation of health changes with the contingent valuation method: a test of scope and question order effects.

In recent years, there has been a growing interest in the contingent valuation method for measurement of monetary values of various commodities. However, the validity and reliability of the method need to be examined thoroughly. This paper reports results of a test of scope and question order effects in a contingent valuation experiment in the health care field. Using three binary valuation questions, data were collected on willingness to pay for superior treatment of reflux oesophagitis. To test for scope effects, different probabilities of successful short- and long-term treatments were evaluated using a split sample approach. The presence of question order effects was tested by assigning respondents to different question orders. The contingent valuation method proved sensitive to changes in scope in that the willingness to pay increased with the probability of being free from symptoms and with a reduced risk of having a relapse once recovered. Also, regression analysis indicate that people who suffer from severe reflux oesophagitis are more willing to pay for more effective treatment. No question order effects were detected in the data.