[Two thirds of patients with gastroesophageal reflux have nocturnal symptoms: survey by 562 general practitioners of 36,663 patients]. / Deux tiers des malades ayant un reflux gastro-oesophagien ont des symptômes nocturnes: enquête réalisée par 562 médecins auprès de 36,663 patients.

OBJECTIVE: Gastroesophageal reflux disease (GERD) affects about 10% of the French population, who have symptoms at least weekly. Nocturnal symptoms are associated with more severe disease. The aim of this study was to determine the prevalence of nocturnal reflux symptoms among patients seeing general practitioners and to assess their consequences on sleep quality. METHODS: For three consecutive days, 562 general practitioners identified among all the adult patients they saw those with GERD symptoms (heartburn or regurgitation) in the previous 3 months and characterized the symptoms. RESULTS: Prevalence of GERD among the 36663 consulting patients was 8.3%, and 64.6% of them (that is, 5.4% of the general population) reported nocturnal GERD. Patients with nocturnal symptoms did not differ from those with only diurnal symptoms except smokers had a significantly higher rate of nocturnal than diurnal symptoms (28 versus 23%, p=0.0053). GERD symptoms were related to nocturnal awakening in 58.6% of patients, were present in the early morning for 41.6% and in the evening at bedtime for 39.5%. Nocturnal awakening, difficulty in falling asleep and nightmares occurred significantly more frequently in patients with nocturnal symptoms (respectively 56 versus 24%; 41 versus 31%; 14 versus 9%). Likewise, atypical nondigestive symptoms occurred significantly more frequently in patients with nocturnal symptoms (74 versus 51%, p<0.0001). Quality of sleep was considered "poor or very poor" more frequently in patients with nocturnal symptoms (58 versus 34%, p<0.0001). CONCLUSION: Approximately 2/3 of GERD patients have nocturnal symptoms that appear to have a significant negative impact on sleep and well-being. These results show the need to evaluate specific therapeutic approaches to reduce sleep disturbances in these patients.

First evaluation using a validated scale of the risk of congestive heart failure among hypertensive patients treated by general practitioners (O-PREDICT survey).

BACKGROUND: Routine management of hypertensive adults is based on assessment of risk factors for coronary artery disease; risk factors for heart failure (HF) remain poorly investigated despite the key role of hypertension in HF development. AIM: To assess the components of HF risk in hypertensive adults in primary care, compare physicians' estimations of HF and global cardiovascular risks with established calculation algorithms, and assess the concordance of these algorithms. METHODS: O-PREDICT was a transverse, observational, multicentre French survey conducted in 2006 among general practitioners who included the first hypertensive, non-HF patient seen in each of three age classes (<60, 60-70, >70 years). Estimations of HF and global cardiovascular risks (at 4 and 10 years, respectively) were performed subjectively during the consultation and calculated a posteriori according to algorithms from the Framingham cohort and the European SCORE database, respectively. For each of these methods, patients were stratified into four risk categories (i.e., no, low, moderate, high). RESULTS: One thousand five hundred and thirty seven physicians recruited 4523 patients (61% men; 64.5+/-10.9 years; systolic blood pressure 149.9+/-15.4 mmHg); most (67.2%) patients had one or two cardiovascular/HF risk factors (dyslipidaemia 48.8%, left ventricular hypertrophy 25.3%, diabetes 18.8%, coronary artery disease 8.8%, valvulopathy 6.1%); the number increased with advancing age and in men versus women. According to the Framingham algorithm, the risk of HF (mean 5.4+/-8.5%; 13.4% of patients at high risk) increased with advancing age (p<0.001), nearly doubling for each decade increase. According to the European SCORE system, global cardiovascular risk (mean 5.4+/-4.3%) was moderate or elevated in 48.1% of patients. Concordance between physicians' estimations and theoretical calculations for HF and global risks was poor, as was concordance between algorithms (kappa(w)=0.28, 0.12, 0.11, respectively). CONCLUSION: More than one in 10 hypertensive patients seen in primary care is at high risk of HF at 4 years according to the Framingham model; this algorithm appears to offer additional information to that provided by the SCORE system. Physicians' estimations of risks correlated poorly with algorithm calculations, suggesting that the use of these tools in general practice should be encouraged.