AstraZeneca RD, Mlndal, Sweden.
Clin Drug Investig. 2011 Oct 1;31(10):703-15. doi: 10.2165/11595480-000000000-00000.
Research on the negative impact of gastro-oesophageal reflux disease (GORD) on the health-related quality of life (HR-QOL) and resource utilization of patients with persistent and intense GORD symptoms despite proton pump inhibitor (PPI) therapy is lacking. The aim of this study was to describe the population of patients with GORD with persistent moderate-to-severe symptoms despite ongoing PPI therapy, and to compare their HR-QOL and healthcare resource use with patients with low GORD symptom load during ongoing PPI therapy.
In this post hoc analysis of the 2007 National Health and Wellness Survey (NHWS), PPI-compliant (≥22 days with PPI use in the past month) European (France, Germany and the UK) and US respondents with physician-diagnosed GORD were stratified into those with persistent and intense GORD symptoms, those with low symptom load, or an intermediate group.
5672 PPI-compliant respondents were identified (persistent and intense symptoms, n = 1741; low symptom load, n = 1805; intermediate group, n = 2126). Respondents with persistent and intense symptoms had poorer HR-QOL than patients with a low symptom load, but none of the differences were statistically significant. Respondents with persistent and intense symptoms also reported lower work productivity (all countries; significant difference [p < 0.01] only in the US), greater activity impairment (all countries; significant difference [p < 0.01] only in the US) and more hours missed from work due to health problems (US, UK and Germany; significant difference [p < 0.01] only in the US). In the UK and US, respondents with persistent and intense symptoms reported significantly more visits to both primary-care physicians and specialists than respondents with a low symptom load (all p < 0.01). Additionally, US respondents with persistent and intense symptoms reported significantly more emergency room visits (p < 0.01).
The 2007 NHWS gives support to the hypothesis that persistent and intense GORD symptoms despite PPI therapy have a significant and negative impact on both HR-QOL and healthcare resource utilization. These findings outline the need for new treatment options for symptomatic GORD patients taking PPI therapy.
研究质子泵抑制剂（PPI）治疗后仍存在持续性和剧烈胃食管反流病（GORD）对患者健康相关生活质量（HR-QOL）和资源利用的负面影响的研究较少。本研究旨在描述 PPI 治疗后仍存在持续性中度至重度 GORD 症状的患者人群，并比较这些患者与 PPI 治疗期间低 GORD 症状负担患者的 HR-QOL 和医疗资源使用情况。
在 2007 年全国健康和健康调查（NHWS）的事后分析中，符合 PPI 标准（过去一个月中有≥22 天使用 PPI）的欧洲（法国、德国和英国）和美国有医生诊断为 GORD 的受访者根据持续性和剧烈 GORD 症状、低症状负担或中间组进行分层。
确定了 5672 名符合 PPI 标准的受访者（持续性和剧烈症状组，n=1741；低症状负担组，n=1805；中间组，n=2126）。持续性和剧烈症状患者的 HR-QOL 较低症状负担患者差，但无统计学差异。持续性和剧烈症状患者的工作生产力也较低（所有国家；仅在美国有显著差异[P<0.01]），活动能力受损更严重（所有国家；仅在美国有显著差异[P<0.01]），因健康问题旷工时间更长（美国、英国和德国；仅在美国有显著差异[P<0.01]）。在英国和美国，持续性和剧烈症状患者报告的初级保健医生和专科医生就诊次数明显多于低症状负担患者（所有 P<0.01）。此外，持续性和剧烈症状的美国受访者报告的急诊就诊次数明显更多（P<0.01）。
2007 年 NHWS 支持这样一种假设，即在 PPI 治疗后仍存在持续性和剧烈的 GORD 症状对 HR-QOL 和医疗资源的利用都有显著的负面影响。这些发现表明需要为接受 PPI 治疗的有症状 GORD 患者提供新的治疗选择。
