Treating GERD Successfully: Beyond Heartburn Relief

Summary and Comment |
May 17, 2013

Treating GERD Successfully: Beyond Heartburn Relief

  1. David A. Johnson, MD

A short questionnaire helps identify whether patients on therapy for GERD are experiencing sleep disturbance and might benefit from an adjustment in therapy.

  1. David A. Johnson, MD

Gastroesophageal reflux disease (GERD) and sleep disturbance are highly prevalent conditions that occur together in many patients. Recent studies have demonstrated that effective treatment of GERD also ameliorates related sleep dysfunction. Proton-pump inhibitors (PPIs) have been demonstrated to improve quality of life, work productivity, and driving acuity (Am J Gastroenterol 2011; 106:421). However, data have been limited to gastroenterology practice settings. In the current primary-care–based, industry-funded, cluster-randomized, open-label study, researchers evaluated the performance of a questionnaire in identifying sleep disturbance in patients being treated for GERD and, secondarily, the efficacy of esomeprazole in improving sleep disturbance.

From 180 primary care centers in Canada, 1388 patients were administered the PPI Acid Suppression Symptom (PASS) test, a validated questionnaire of five questions that identifies symptoms in patients on continuing acid-suppression therapy for GERD. One item regards sleep disturbance. Among the 825 patients who described sleep disturbance at baseline, 534 patients at 111 centers were randomized to switch from their current antisecretory therapy to once-daily esomeprazole (20 mg or 40 mg; intervention), and 291 patients at 69 centers were randomized to continue current therapy (control). At 4 weeks, 23% of patients in the intervention group versus 55% in the control group reported continued sleep disturbance (odds ratio, 2.3; 95% confidence interval, 0.17–0.32). Mean improvements in quality-of-life scores and reflux symptom scores were higher in the intervention group than in the control group.


Primary care providers (and, I suspect, many gastroenterologists) need to better recognize the implications of inadequate gastroesophageal reflux disease treatment, including sleep disturbance, which in many patients will respond to a change in acid-suppressive therapy. Whether a formal questionnaire is necessary for screening versus pragmatic and attentive questioning probably depends on the provider. Defining successful treatment for GERD means setting appropriate endpoints beyond just heartburn relief.


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