Am I Winning or Losing? Probing the Appraisal of Partial Wins via Response Vigor.

Attempts to obtain rewards are not always successful. Despite investing much time, effort, or money, sometimes individuals may not obtain any reward. Other times they may obtain some reward, but the obtained reward may be smaller than their initial investment, such as partial wins in gambling. It remains unclear how such ambiguous outcomes are appraised. To address this question, we systematically varied the payoffs for different outcomes in a computerized scratch card task across three experiments. To test outcome appraisal, we used response vigor as a novel proxy. In the scratch card task, participants turned three cards one by one. Depending on the turned cards, they either received an amount that was higher than the wager (win), an amount lower than the wager (partial win), or nothing (loss). Overall, participants responded to partial wins more slowly than losses, but more quickly than wins. Partial wins were therefore appraised to be better than losses, but worse than wins. Importantly, further analyses showed that outcome appraisal was not based on the net win or loss amount. Instead, participants primarily used the configuration of turned cards as a cue for the relative rank of an outcome within a specific game. Outcome appraisals thus utilize simple heuristic rules, rely on salient information (such as outcome-related cues in gambling), and are specific to a local context. Together, these factors may contribute to the misperception of partial wins as real wins in gambling. Future work may examine how outcome appraisal may be modulated by the salience of certain information, and investigate the appraisal process in contexts beyond gambling.

miR-99a/100~125b tricistrons regulate hematopoietic stem and progenitor cell homeostasis by shifting the balance between TGFß and Wnt signaling.

Although regulation of stem cell homeostasis by microRNAs (miRNAs) is well studied, it is unclear how individual miRNAs genomically encoded within an organized polycistron can interact to induce an integrated phenotype. miR-99a/100, let-7, and miR-125b paralogs are encoded in two tricistrons on human chromosomes 11 and 21. They are highly expressed in hematopoietic stem cells (HSCs) and acute megakaryoblastic leukemia (AMKL), an aggressive form of leukemia with poor prognosis. Here, we show that miR-99a/100∼125b tricistrons are transcribed as a polycistronic message transactivated by the homeobox transcription factor HOXA10. Integrative analysis of global gene expression profiling, miRNA target prediction, and pathway architecture revealed that miR-99a/100, let-7, and miR-125b functionally converge at the combinatorial block of the transforming growth factor ß (TGFß) pathway by targeting four receptor subunits and two SMAD signaling transducers. In addition, down-regulation of tumor suppressor genes adenomatous polyposis coli (APC)/APC2 stabilizes active ß-catenin and enhances Wnt signaling. By switching the balance between Wnt and TGFß signaling, the concerted action of these tricistronic miRNAs promoted sustained expansion of murine and human HSCs in vitro or in vivo while favoring megakaryocytic differentiation. Hence, our study explains the high phylogenetic conservation of the miR-99a/100∼125b tricistrons controlling stem cell homeostasis, the deregulation of which contributes to the development of AMKL.

More insight into the interplay of response selection and visual attention in dual-tasks: masked visual search and response selection are performed in parallel.

Both response selection and visual attention are limited in capacity. According to the central bottleneck model, the response selection processes of two tasks in a dual-task situation are performed sequentially. In conjunction search, visual attention is required to select the items and to bind their features (e.g., color and form), which results in a serial search process. Search time increases as items are added to the search display (i.e., set size effect). When the search display is masked, visual attention deployment is restricted to a brief period of time and target detection decreases as a function of set size. Here, we investigated whether response selection and visual attention (i.e., feature binding) rely on a common or on distinct capacity limitations. In four dual-task experiments, participants completed an auditory Task 1 and a conjunction search Task 2 that were presented with an experimentally modulated temporal interval between them (Stimulus Onset Asynchrony, SOA). In Experiment 1, Task 1 was a two-choice discrimination task and the conjunction search display was not masked. In Experiment 2, the response selection difficulty in Task 1 was increased to a four-choice discrimination and the search task was the same as in Experiment 1. We applied the locus-of-slack method in both experiments to analyze conjunction search time, that is, we compared the set size effects across SOAs. Similar set size effects across SOAs (i.e., additive effects of SOA and set size) would indicate sequential processing of response selection and visual attention. However, a significantly smaller set size effect at short SOA compared to long SOA (i.e., underadditive interaction of SOA and set size) would indicate parallel processing of response selection and visual attention. In both experiments, we found underadditive interactions of SOA and set size. In Experiments 3 and 4, the conjunction search display in Task 2 was masked. Task 1 was the same as in Experiments 1 and 2, respectively. In both experiments, the d' analysis revealed that response selection did not affect target detection. Overall, Experiments 1-4 indicated that neither the response selection difficulty in the auditory Task 1 (i.e., two-choice vs. four-choice) nor the type of presentation of the search display in Task 2 (i.e., not masked vs. masked) impaired parallel processing of response selection and conjunction search. We concluded that in general, response selection and visual attention (i.e., feature binding) rely on distinct capacity limitations.

The impact of free-order and sequential-order instructions on task-order regulation in dual tasks.

Dual tasks (DTs) are characterized by the requirement for additional mechanisms that coordinate the processing order of two temporally overlapping tasks. These mechanisms are indicated by two types of costs that occur when comparing DT blocks with fixed and random orders of the component tasks. On a block level, task-order control costs are reflected in increased reaction times (RTs) in random-order compared to fixed-order blocks, indicating global, monitoring-based, coordination mechanisms. On a trial level, within random-order blocks, order-switch costs are indicated by increased RTs on order switch compared to order repetition trials, reflecting memory-based mechanisms that guide task-order in DTs. To test the nature of these mechanisms in two experiments, participants performed DTs in fixed- and random-order blocks. In random-order blocks, participants were either instructed to respond to both tasks according to the order of task presentation (sequential-order instruction) or instructed to freely decide in which order to perform both tasks (free-order instruction). As a result of both experiments, we demonstrated that task-order control costs were reduced under the free-order compared to the sequential-order instruction, whereas order-switch costs were not affected by our instruction manipulation. This pattern of results suggests that the task-order control costs reflect global processes of task-order regulation such as engaging monitoring processes that are sensitive to changes in order instructions, while order-switch costs reflect rather local memory-based mechanisms that occur irrespective of any effort to coordinate task-order.

Psychometric evaluation of a daily gastro-oesophageal reflux disease symptom measure.

OBJECTIVE: The objective of this study was to evaluate the validity of the Heartburn Reflux Dyspepsia Questionnaire (HRDQ), a newly developed measure of gastro-oesophageal reflux disease (GORD) symptoms. Specifically, the HRDQ was developed for patients, who still experience symptoms with proton pump inhibitor (PPI) treatment. MATERIAL AND METHODS: The psychometric properties of HRDQ were evaluated based on data from two clinical trials of patients with GORD with a partial response to PPIs, one from the UK and one from Denmark and Germany. RESULTS: The HRDQ had good internal consistency (Cronbach's alpha range .83-.88) and test-retest reliability (intraclass correlation coefficient range .71-.90). Convergent and discriminant validity were supported by high correlations with ReQuest™ and ability to differentiate between groups based on ReQuest™ cut-off values. Responsiveness of HRDQ was demonstrated by moderate to high correlations with ReQuest™ change scores and time with symptoms. An HRDQ cut-off value of 0.70 for definition of 'bad day' was also evaluated. CONCLUSIONS: Based on existing evidence, the HRDQ is a valid and reliable measure of GORD symptoms that can be used as a study outcome in clinical trials.

Use of antacids, alginates and proton pump inhibitors: a survey of the general Danish population using an internet panel.

OBJECTIVE: Both over-the-counter medicine, such as antacids or alginates, and proton pump inhibitors (PPI) are used for treating acid-related disorders. We sought to describe what characterizes users of these different medicines, including long-term PPI users within the general population. METHOD: A cross-sectional survey was conducted in an internet panel representative of the Danish adult population in 2012. Data queried included antacid/alginate and PPI use, reason for therapy, co-medication, and presence of upper gastrointestinal symptoms. Long-term PPI use was defined as using PPI ≥1/3 of the last year (∼120 days). Risk of long-term PPI use was estimated by logistic regression. RESULTS: A total of 18,223 people received the questionnaire, of which 52% (9390) responded. Antacid/alginate use was reported by 23%; 16% reported use of only antacid/alginate. PPI use was reported by 13.6%; 6.2% were defined as long-term PPI users. Antacid/alginate users were younger, used less co-medication, had most often started on therapy because of reflux symptoms, and had less often ongoing symptoms. Risk of long-term PPI use appeared to be increased in male gender, by renewing PPI prescription by phone/e-mail, using co-medication, and having started on PPI for several reasons. Combination of antacid/alginate and PPI was reported by approximately 50% of those on therapy with weekly or daily symptoms. CONCLUSION: 23% of Danish adults were using antacids or alginates and 14% were using PPI, of which one-half were on long-term therapy. Prescription renewal by phone or e-mail and use of other prescription medication were associated with long-term PPI use, indicating a behavioral pattern, in which unnecessary PPI therapy may be maintained.

The spectrum of ELANE mutations and their implications in severe congenital and cyclic neutropenia.

Neutrophil elastase gene (ELANE) mutations are responsible for the majority of cases of severe congenital neutropenia (CN) and cyclic neutropenia (CyN). We screened CN (n = 395) or CyN (n = 92) patients for ELANE mutations and investigated the impact of mutations on mRNA expression, protein expression, and activity. We found 116 different mutations in 162 (41%) CN patients and 26 in 51 (55%) CyN patients, 69 of them were novel. CyN-associated mutations were predicted to be more benign than CN-associated mutations, but the mutation severity largely overlapped. The frequency of acquired CSF3R mutations, malignant transformation, and the need for hematopoietic stem cell transplantation was significantly higher in CN patients with ELANE mutation than in ELANE mutation negative patients. Cellular elastase activity was reduced in neutrophils from CN/CyN patients, irrespective of the mutation status. In CN, enzymatic activity was significantly lower in patients with ELANE mutations compared with those with wild-type ELANE. Despite differences in the spectrum of mutations in CN or CyN, type or localization of mutation only partially determine the clinical phenotype. Specific ELANE mutations have limited predictive value for leukemogenesis; the risk for leukemia was correlated with disease severity rather than with occurrence of an ELANE mutation.

Systematic review: symptoms of rebound acid hypersecretion following proton pump inhibitor treatment.

INTRODUCTION: While the physiological existence of rebound acid hypersecretion (RAHS) after withdrawal of proton pump inhibitors (PPI) therapy is established, the clinical implications are less certain. It has been speculated that a clinical relevant rebound phenomenon may be responsible for difficulties in getting off acid-suppressive medication and partly explain the increase in long-term use of PPI. A number of studies addressing this issue have been published recently. The authors aimed to systematically review the existing evidence of clinically relevant symptoms caused by acid rebound following PPI treatment. MATERIAL AND METHODS: PubMed was searched using the terms "rebound acid hypersecretion" and generic names of PPIs. RESULTS: Five studies were included. Two studies on asymptomatic volunteers found that 44% experienced acid-related symptoms up to 4 weeks after treatment was withdrawn. Symptoms were generally mild to moderate and mainly heartburn and regurgitation. Three studies, using patients with reflux disease, found no signs of symptoms caused by acid rebound. CONCLUSION: Gastric acid rebound hypersecretion following PPI therapy induces reflux-like symptoms post-treatment in asymptomatic volunteers, but the significance of this in patient populations is not clear. The studies in patients with reflux disease found no evidence of symptomatic RAHS, but these studies were hampered by severe methodological weaknesses.

Research on Rare Diseases in Germany - The cancer predisposition syndrome registry.

Background: Cancer predisposition syndromes (CPS) are rare diseases that are associated with an increased risk of cancer due to genetic alterations. At least 8 % of all cases of childhood cancer are attributable to CPS [1, 2]. The CPS registry was launched in 2017 to learn more about CPS and to improve the care to those afflicted by these diseases. Methods: This is an internationally networked registry with associated accompanying studies that investigate cancer risks and spectra, the possibilities of cancer prevention, early detection and therapy. Results: For several of these syndromes, new insights into the cancer risks and cancer types as well as factors modifying cancer risk have been gained. In addition, experimental, psycho-oncological, preclinical and clinical studies were initiated. Conclusions: The CPS registry is an example of how progress can be made within a short period of time to the benefit of individuals with rare diseases through systematic data collection and research.

Fermented milk for hypertension.

BACKGROUND: Fermented milk has been suggested to have a blood pressure lowering effect through increased content of proteins and peptides produced during the bacterial fermentation. Hypertension is one of the major risk factors for cardiovascular disease world wide and new blood pressure reducing lifestyle interventions, such as fermented milk, would be of great importance. OBJECTIVES: To investigate whether fermented milk or similar products produced by lactobacilli fermentation of milk proteins has any blood pressure lowering effect in humans when compared to no treatment or placebo. SEARCH METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), English language databases, including MEDLINE (1966-2011), EMBASE (1974-2011), Cochrane Complementary Medicine Trials Register, Allied and Complementary Medicine (AMED) (1985-2011), Food science and technology abstracts (1969-2011). SELECTION CRITERIA: Randomised controlled trials; cross over and parallel studies evaluating the effect on blood pressure of fermented milk in humans with an intervention period of 4 weeks or longer. DATA COLLECTION AND ANALYSIS: Data was extracted individually by two authors, afterwards agreement had to be obtained before imputation in the review. MAIN RESULTS: A modest overall effect of fermented milk on SBP was found (MD -2.45; 95% CI -4.30 to -0.60), no effect was evident on DBP (MD -0.67; 95% CI -1.48, 0.14). AUTHORS' CONCLUSIONS: The review does not support an effect of fermented milk on blood pressure. Despite the positive effect on SBP the authors conclude, for several reasons, that fermented milk has no effect on blood pressure. The effect found was very modest and only on SBP, the included studies were very heterogeneous and several with weak methodology. Finally, sensitivity and subgroup analyses could not reproduce the antihypertensive effect. The results do not give notion to the use of fermented milk as treatment for hypertension or as a lifestyle intervention for pre-hypertension nor would it influence population blood pressure.

Benefits and costs of self-paced preparation of novel task instructions.

Rapidly executing novel instructions is a critical ability. However, it remains unclear whether longer preparation of novel instructions improves performance, and if so, whether this link is modulated by performance benefits and costs of preparation. Regarding the first question, we reanalysed previous data on novel instruction implementation and ran Experiment 1. Experiment 1 consisted of multiple mini-blocks, in which participants prepared four novel stimulus-response (S-R) mappings in a self-paced instruction phase. After participants indicated they were ready, one of the four stimuli was presented and they responded. The reanalysis and Experiment 1 showed that longer preparation indeed led to better performance. To examine if preparation was modulated when the benefits of preparation were reduced, we presented the correct response with the stimulus on some trials in Experiments 2 and 3. Preparation was shorter when the probability that the correct response was presented with the stimulus increased. In Experiment 4, we manipulated the costs of preparation by changing the S-R mappings between the instruction and execution phases on some trials. This had only limited effects on preparation time. In conclusion, self-paced preparation of novel instructions comes with performance benefits and costs, and participants adjust their preparation strategy to the task context.

Saccadic eye movements in dual tasking: No impairment of spatial planning, but delayed execution of saccades.

In the target-distractor saccade task, a target and an irrelevant distractor are simultaneously presented and the task itself consists of a target-directed saccade. Findings usually show that as saccade latency increases, saccade trajectory deviation towards the distractor decreases. We presented this saccade task in two dual-task experiments to address the open question of whether performance of an auditory-manual task simply delays the temporal execution of a saccade, or whether it also interferes with the spatial planning of the saccade trajectory. We measured saccade latency, as a measure of a delay in execution, and saccade trajectory deviation, as a measure of the spatial planning. In Experiment 1, the auditory-manual task was a two-choice reaction time (two-CRT) task, and in Experiment 2, it was a go-no-go task. Performing the two tasks in close temporal succession shortly delayed the temporal execution of the saccade, but did not influence the spatial planning of the saccade trajectory. This result pattern was more pronounced when the auditory-manual task required the selection and execution of one of two possible manual responses (Experiment 1), less pronounced when the auditory-manual task required the decision to execute a button press (go condition, Experiment 2), and absent when the auditory-manual task required the decision to inhibit a button press (no-go condition, Experiment 2). Taken together, the manual response rather than the response selection process of the auditory-manual task led to a delay of saccade execution, but not to an impairment of the spatial planning of the saccade trajectory.

Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy.

BACKGROUND & AIMS: Rebound acid hypersecretion (RAHS) has been demonstrated after 8 weeks of treatment with a proton-pump inhibitor (PPI). If RAHS induces acid-related symptoms, this might lead to PPI dependency and thus have important implications. METHODS: A randomized, double-blind, placebo-controlled trial with 120 healthy volunteers was conducted. Participants were randomized to 12 weeks of placebo or 8 weeks of esomeprazole 40 mg/d followed by 4 weeks with placebo. The Gastrointestinal Symptom Rating Scale (GSRS) was filled out weekly. A score of >2 on 1 of the questions regarding heartburn, acid regurgitation, or dyspepsia was defined as a clinically relevant acid-related symptom. RESULTS: There were no significant differences between groups in GSRS scores at baseline. GSRS scores for acid-related symptoms were significantly higher in the PPI group at week 10 (1.4 +/- 1.4 vs 1.2 +/- 0.9; P = .023), week 11 (1.4 +/- 1.4 vs 1.2 +/- 0.9; P = .009), and week 12 (1.3 +/- 1.2 vs 1.0 +/- 0.3; P = .001). Forty-four percent (26/59) of those randomized to PPI reported > or = 1 relevant, acid-related symptom in weeks 9-12 compared with 15% (9/59; P < .001) in the placebo group. The proportion reporting dyspepsia, heartburn, or acid regurgitation in the PPI group was 13 of 59 (22%) at week 10, 13 of 59 (22%) at week 11, and 12 of 58 (21%) at week 12. Corresponding figures in the placebo group were 7% at week 10 (P = .034), 5% at week 11 (P = .013), and 2% at week 12 (P = .001). CONCLUSIONS: PPI therapy for 8 weeks induces acid-related symptoms in healthy volunteers after withdrawal. This study indicates unrecognized aspects of PPI withdrawal and supports the hypothesis that RAHS has clinical implications.

Dissociating central and auditory attention: Is there a shared bottleneck for response selection and auditory search?

Central and auditory attention are limited in capacity. In dual-tasks, central attention is required to select the appropriate response, but because central attention is limited in capacity, response selection can only be carried out for one task at a time. In auditory search tasks, search time to detect the target sound increases with the number of distractor sounds added to the auditory scene (set sizes), indicating that auditory attention is limited in capacity. Here, we investigated whether central and auditory attention relied on common or distinct capacity limitations using a dual-task paradigm. In two experiments, participants completed a visual choice discrimination task (task 1) together with an auditory search task (task 2), and the two tasks were separated by an experimentally modulated stimulus onset asynchrony (SOA). Analysing auditory search time as a function of SOA and set sizes (locus-of-slack method) revealed that the auditory search process in task 2 was performed after response selection in a visual two-choice discrimination task 1 (Experiment 1), but concurrently with response selection in a visual four-choice discrimination task 1 (Experiment 2). Hence, although response selection in the visual four-choice discrimination task demanded more central attention as compared with response selection in the two-choice discrimination task, the auditory search process was performed in parallel. Distribution analyses of inter-response time further indicated that parallel processing of response selection and auditory search was not influenced by response grouping. Taken together, the two experiments provided evidence that central and auditory attention relied on distinct capacity limitations.

Visual and central attention share a capacity limitation when the demands for serial item selection in visual search are high.

Visual and central attention are limited in capacity. In conjunction search, visual attention is required to select the items and to bind their features (e.g., color, form, size), which results in a serial search process. In dual-tasks, central attention is required for response selection, but because central attention is limited in capacity, response selection can only be carried out for one task at a time. Here, we investigated whether visual and central attention rely on a common or on distinct capacity limitations. In two dual-task experiments, participants completed an auditory two-choice discrimination Task 1 and a conjunction search Task 2 that were presented with an experimentally modulated temporal interval between them (stimulus onset asynchrony [SOA]). In Experiment 1, Task 2 was a triple conjunction search task. Each item consisted of a conjunction of three features, so that target and distractors shared two features. In Experiment 2, Task 2 was a plus conjunction search task, in which target and distractors shared the same four features. The hypotheses for conjunction search time were derived from the locus-of-slack method. While plus conjunction search was performed after response selection in Task 1, a small part of triple conjunction search was still performed in parallel to response selection in Task 1. However, the between-experiment comparison was not significant, indicating that both search tasks may require central attention. Taken together, the present study provides evidence that visual and central attention share a common capacity limitation when conjunction search relies strongly on serial item selection.

A population-based survey to assess troublesome symptoms in gastroesophageal reflux disease.

OBJECTIVE: A simple frequency and severity threshold for categorizing reflux symptoms as troublesome has been suggested, but there is a lack of confirmatory studies for this threshold. The objectives of this study were to examine the characteristics for troublesome symptoms and to compare different ways of categorizing reflux symptoms as troublesome. MATERIAL AND METHODS: Members of a web panel responding to an e-mail invitation (1623/3506, median age interval 40-44 years, 51% female) who reported reflux symptoms during the preceding 4 weeks (n=1284) were linked to the full questionnaire. Associations between self-reported troublesome symptoms (10-graded VAS) and troublesome symptoms (mild symptoms >1 day/week or moderate/severe symptoms > or = 1 day/week) and clinical characteristics were analyzed. RESULTS: Out of 1284 subjects, 482 (38%) reported reflux symptoms. Agreement on the classification of troublesome symptoms based on frequency and severity and self-reported troublesome symptoms was poor to fair. Using 4 as the cut-off point on the VAS showed the best agreement (kappa = 0.35). Of the 482 symptomatic respondents, 266 (55%) had troublesome symptoms based on frequency and severity and 274 (57%) had self-reported troublesome symptoms. Subjects (n=80) who had self-reported troublesome symptoms, but were not categorized as having troublesome symptoms based on frequency and severity, reported health concerns, work productivity loss and medical treatment significantly more often (p< or =0.03) than subjects (n=194) with troublesome symptoms according to both categorizations. CONCLUSIONS: Classification of troublesome reflux symptoms based on frequency and severity is too simplistic. Health concerns, disrupted work productivity and night-time symptoms add to the perception of symptoms as troublesome.

Open Up - the Mission Statement of the Control of Impulsive Action (Ctrl-ImpAct) Lab on Open Science.

The present paper is the mission statement of the Control of Impulsive Action (Ctrl-ImpAct) Lab regarding Open Science. As early-career researchers (ECRs) in the lab, we first state our personal motivation to conduct research based on the principles of Open Science. We then describe how we incorporate four specific Open Science practices (i.e., Open Methodology, Open Data, Open Source, and Open Access) into our scientific workflow. In more detail, we explain how Open Science practices are embedded into the so-called 'co-pilot' system in our lab. The 'co-pilot' researcher is involved in all tasks of the 'pilot' researcher, that is designing a study, double-checking experimental and data analysis scripts, as well as writing the manuscript. The lab has set up this co-pilot system to increase transparency, reduce potential errors that could occur during the entire workflow, and to intensify collaborations between lab members. Finally, we discuss potential solutions for general problems that could arise when practicing Open Science.

The Movement-Image Compatibility Effect: Embodiment Theory Interpretations of Motor Resonance With Digitized Photographs, Drawings, and Paintings.

To evoke the impression of movement in the "immobile" image is one of the central motivations of the visual art, and the activating effect of images has been discussed in art psychology already some 100 years ago. However, this topic has up to now been largely neglected by the researchers in cognitive psychology and neuroscience. This study investigates - from an interdisciplinary perspective - the formation of lateralized instances of motion when an observer perceives movement in an image. A first step was to identify images that evoke a perception of movement in a certain direction and to give this a rating. Reaction times leading to the engagement of a joystick following the presentation of images are used to evidence the postulated movement occasioned by the perception of movement in an image. Where the required direction of joystick moves matched the expected perception of movement direction in the image, significantly shorter reaction times were recorded. The experiment was able to prove a "movement-image compatibility effect" in observers of images. Based on this, the paper revisits and brings up to date the theses on motor sensory response to images which were developed in art psychology at the beginning of the 20th century. It furthermore contributes an embodiment theory interpretation to the prevalent representational explanation of compatibility effects.

Perceptions and beliefs concerning gastroesophageal reflux disease: physicians and patients disagree.

BACKGROUND/AIM: There is insufficient evidence to support an association between lifestyle and gastroesophageal reflux disease (GERD). Furthermore, perceptions concerning the impact of GERD on lifestyle are largely unknown. We aimed at investigating physicians' perceptions about GERD and lifestyle and at evaluating physician-patient agreement concerning the impact of GERD on the quality of life. METHODS: A questionnaire was mailed to all Danish primary care physicians (n = 3,603, response rate 36%) and to all Danish gastroenterologists (n = 624, response rate 50%). Another questionnaire was completed by 176 GERD patients on medical therapy (84% on proton pump inhibitors). RESULTS: 35% of the physicians believe GERD is predominantly caused by lifestyle and 51% always recommend lifestyle modifications. According to the physicians, the three most frequently affected aspects of quality of life were sleep disturbances (24%), limitations in physical activities (22%) and tiredness (18%). However, according to the patients, the three most frequently reported aspects were dietary restrictions (63%), tiredness/lack of energy (49%) and health concerns (44%). 70% of the physicians considered complete absence of symptoms as a useful goal for therapy. 72% of the patients reported recent symptoms, despite therapy and self-imposed lifestyle restrictions. CONCLUSIONS: Physicians and GERD patients disagree on impairments of quality of life. Many patients reported frequent symptoms despite therapy and self-imposed lifestyle restrictions.