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Right Match of Drug, Doctor Can Boost Reflux Outcomes

Review finds PPIs may perform better, and good rapport with physician is key,,

FRIDAY, Aug. 21 (HealthDay News) -- Chronic heartburn caused by acid reflux is one of the most common complaints among Americans, and a new study outlines which approaches appear to work best to ease patients' suffering.

The Danish study found that people with the condition -- formally called gastroesophageal reflux disease (GERD) -- typically feel best when placed on medications called proton pump inhibitors (PPIs) by a doctor with whom they have a good rapport.

"The treatment we have isn't always perfect," conceded Dr. Maria T. Abreu, professor of medicine and chief of the division of gastroenterology at the University of Miami Miller School of Medicine, who was not involved in the study. She agreed that communicating well with patients can go a long way toward increasing their satisfaction, because reflux treatments don't always relieve all symptoms. If doctors said that up front, patients "might be more likely to feel satisfied," Abreu said.

The report is published in the August issue of Clinical Gastroenterology and Hepatology.

For the study, Dr. Peter Bytzer, from Copenhagen University, reviewed 11 studies published between 1970 and 2007. Each study examined the reasons why people were satisfied or dissatisfied with their GERD treatment.

"Patient satisfaction can be influenced by a number of factors including treatment regimen, general level of well-being, the 'bedside manner' of the physician, the patient's expectations and the quality of patient/physician communication," Bytzer said in a news release from the American Gastroenterological Association.

He found that patients given prescriptions for proton pump inhibitors (PPIs) -- drugs that include blockbusters such as Prevacid, Prilosec and Nexium -- were more satisfied with their treatment than those given H2-receptor antagonists, which include Tagamet and Zantac. And, not surprisingly, people whose symptoms were only partially relieved were less satisfied than patients whose symptoms were completely relieved.

Although prescription medications can help relieve the symptoms of GERD, studies have shown that some patients are still not satisfied with their treatment. In fact, at least one-third of people taking any medication for chronic reflux remain unsatisfied with their treatment. This is particularly true for those taking over-the-counter medicines, Bytzer noted.

Abreu agreed that even PPIs don't work for everyone. There are a range of conditions all classified as GERD and while it is that true GERD responds well to these medications, other forms of heartburn don't, she said.

The doctor-patient relationship was key, the experts said. If a doctor took their condition seriously and conducted a thorough examination, patients were more likely to say they were happy with their care. They were also more likely to be satisfied if they interacted well with their doctor, Bytzer reports.

When doctors cannot resolve a medical problem they sometimes end up not taking the patient seriously, Abreu said. "They do not feel invested in the problem. They don't feel like they can really make it better," she said. And that can be a definite turn-off for patients. "People want to feel that at least you have taken it seriously," Abreu said.

In most cases, the doctor/patient relationship can be fixed, however.

"Of the various factors influencing patient satisfaction, the quality of patient/physician communication is probably the most amenable to improvement," Bytzer stated in the news release. "This can be done by using validated questionnaires to help physicians identify more effectively which symptoms patients have, and the impact of these symptoms on the patient's well-being," he added.

Medication and communication are not the only steps patients can take to improve their symptoms and quality of life, Abreu said.

"There is a lot of stuff related to heartburn that can be changed with lifestyle," she said. "For example, not eating a big meal before going to bed. But patients are reluctant to change lifestyle -- they would rather just take medicine."

More information

For more information on GERD, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Maria T. Abreu, M.D., professor, medicine, chief, division of gastroenterology, University of Miami Miller School of Medicine; American Gastroenterological Association, news release, Aug. 3, 2009; August 2009, Clinical Gastroenterology and Hepatology

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