May 19, 2008 Despite daily use of doctor-recommended proton pump inhibitors (PPIs) to control gastroesophageal reflux disease (GERD) symptoms, nearly 40 percent of patients who take them continue to experience breakthrough, which is a return of GERD symptoms, such as acid regurgitation and heartburn. These breakthrough symptoms lead more than half of GERD sufferers to use over-the-counter (OTC) remedies, according to a survey recently conducted by the American Gastroenterological Association (AGA) Institute.
The survey of 1,064 people with GERD found that approximately 56 percent of those who experienced breakthrough used an OTC treatment -- the majority using an antacid -- to manage breakthrough symptoms. Further, taking an OTC in addition to a PPI has become routine for these respondents. In fact, more than 70 percent have been using OTC medications for at least one year.
"The survey results show that people with GERD are not only using their prescribed PPI, but also are turning to over-the-counter remedies as a stop-gap when they have breakthrough symptoms," said John Inadomi, MD, associate professor of medicine, University of California, San Francisco.
Additional survey findings showed that:
- More than 40 percent of respondents on a PPI who experience breakthrough symptoms, report those symptoms occur two to four times per week.
- Respondents report breakthrough symptoms occur throughout the day, sometimes multiple times per day. Sixty-five percent of GERD sufferers experienced breakthrough at night and 28 percent report sleep disruption because of their symptoms.
- Among patients suffering from breakthrough symptoms, at least 50 percent are not fully satisfied with the specific symptom relief (e.g., acid regurgitation and heartburn) they get from their once-daily PPI.
- While 98 percent of respondents who experience breakthrough symptoms report taking their PPI as directed, more than 40 percent have not spoken to their physician about these symptoms.
Nearly two-thirds (57 percent) of respondents report that their physician has not asked about their habitual use of OTC medications, such as Alka-Seltzer, Mylanta, Pepcid Complete and Pepto-Bismol, in addition to their PPI.
"Breakthrough symptoms can be bothersome and frustrating to GERD sufferers, but they aren't talking about it with their physician as often as they should," said Dr. Inadomi. "By discussing the frequency, severity and timing of breakthrough symptoms, physicians and patients can determine if changes need to be made to their GERD treatment."
GERD stands for gastroesophageal reflux disease. It is caused by frequent or regular back up of stomach juices from the stomach into the esophagus. It is estimated that GERD affects between 25-35 percent of the U.S. population. Common symptoms of GERD include: heartburn, dyspepsia, regurgitation, chest sensations or pain, acid laryngitis and dysphagia. Proton pump inhibitors decrease acid production by turning off many of the acid pumps in the stomach.
About the Survey
The survey was conducted by Harris Interactive and funded through a grant by TAP Pharmaceutical Products Inc. The survey consisted of a 10-minute online, self-administered survey. Participants were 40 percent male, 60 percent female. Forty percent of the respondents were under age 49 and 60 percent were 50 and over. All patients suffered from GERD and had been taking a PPI to control their symptoms for at least three months.
The main sample is associated with a margin of sampling error plus or minus 3 percentage points; for results based on subgroups the sampling error is higher. Where comparisons were made, significance testing was done at 95 percent confidence. Testing differences between groups at the 95 percent confidence level indicates that there is no more than a 5 in 100 chance that the difference observed between the groups could have been obtained by chance.
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