/publications/issue/2009/July2009/GERDWatch-0709

GERD Watch

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GERD Awareness Surveyed
A recent survey of individuals' familiarity with gastroesophageal reflux disease (GERD) proved positive. The condition is one of the primary health conditions individuals generally recognize and understand. Of the respondents, >80% were familiar with GERD, and of those, nearly 90% knew that if GERD went untreated, it can lead to more serious health problems.

Despite the levels of awareness, many individuals with GERD still are not taking the proper steps to manage the most commonly reported symptom-nighttime heartburn. The survey revealed that 77% of individuals with GERD experience the condition at night. Yet, only 54% knew that eating late at night can aggravate the symptoms.

Because food can trigger GERD, individuals should avoid certain foods to help control GERD symptoms. The survey found, however, that many patients are reluctant to give up some of these foods. In fact, >80% of patients with GERD indicated that at times they consumed foods or beverages that they knew would give them heartburn. This practice was more popular among patients aged 18 to 34, compared with patients aged 55 and older (94% vs 75%).

Turn Up the Heat
A study reported in the May 28, 2009, issue of the New England Journal of Medicine found that radiofrequency ablation (RFA) works in the treatment of precancerous Barrett's esophagus. A small number of individuals with the condition develop esophageal adenocarcinoma.

For the study, 127 patients received either RFA, which uses heat to destroy abnormal cells, or a "sham" version of the procedure to assess the effect on dysplasia. Of the patients with low-grade dysplasia, 90.5% of those who received RFA were dysplasia-free 12 months after treatment, compared with 22.7% of those in the non-RFA group. Among the patients with high-grade dysplasia, 81% had complete eradication of abnormal cells, compared with 19% in the sham group.

The researchers found that 77.4% of the patients who received RFA had total eradication of abnormal cells, compared with 2.3% of the sham group. The findings also indicated that 3.6% of those in the RFA group and 16.3% of those in the sham group had progression toward disease. Of the patients who developed esophageal adenocarcinoma, 1.2%were in the RFA group and 9.3% were in the non-RFA group.

Study Validates PASS Test for GERD
A new study confirms the use of the PASS test to identify which patients with gastroesophageal reflux disease (GERD) will benefit from switching therapy. The PASS test is a questionnaire of 5 "yes or no" questions given to patients with persistent acid-related upper gastrointestinal symptoms.

The study included 1564 patients with GERD who failed a PASS test. The patients were randomized to an intervention group (n = 973) or a control group (n = 591). The intervention group received 4 weeks of a proton pump inhibitor (PPI) at 20 or 40 mg once daily,and the control group continued on the non-PPI acid-suppression therapy they were already on for an additional 4 weeks. The study's results showed that the patients treated with a PPI had significantly greater improvements in the Global Overall Symptom score, compared with the control group.

After 4 weeks, the test was given to the patients and 345 of 973 (35.5%) patients taking PPI passed the test, compared with 78 of 591 (13.2%) in the control group. The findings were presented at the Digestive Disease Week meeting in June.
 
Heartburn Meds May Up Hip Fracture Risk
New research raised concern about the short-term use of proton pump inhibitors (PPIs) and histamine2-receptor antagonists(H2RAs) and the increased risk of hip fracture.

The findings, presented at the Digestive Disease Week meeting in June, were based on an analysis of data on nearly 40,000 patients taking acid-reducing drugs and >130,000 patients not taking the medications. The patients who had hip fractures were 30% more prone to have taken PPIs for at least 2 years and 18% more likely to have taken H2RAs for at least 2 years.

The risks were reduced in patients who had taken lower doses. The patients who took <1 pill a day had a 12% increase in fracture risk. Patients who took 1 pill a day had a 30%increased risk, compared with a 41% higher risk in patients who exceeded >1 pill a day. The greatest risk of hip fracture was seen in patients aged 50 to 59 who had been on PPIs for>2 years.

The researchers recommended that patients taking acid blockers continue with treatment at the lowest effective dose. Individuals at risk for osteoporosis, however, should consult with their physician about other treatment options.

FAST FACT: Approximately 50 million adults experience GERD symptoms on a frequent basis.