[Prognostic factors for response to treatment and recurrence of uncomplicated symptomatic gastroesophageal reflux in ambulatory care medicine].

OBJECTIVE

To investigate the prognostic factors of symptom resolution or failure and relapse in patients presenting with symptomatic gastroesophageal reflux (GERD) and treated in the usual conditions of primary care.

METHOD: Controlled, non-comparative study consisting of a 4-week treatment phase (omeprazole 10 mg/day) and a 12-week follow-up phase. Initial symptom resolution was defined as no heartburn in the week preceding the assessment at the end of treatment. Following initial symptom resolution, relapse was defined as the occurrence of moderate or severe heartburn and/or acid regurgitation, and/or ingestion of antisecretory agents or prokinetics, or the existence of symptoms justifying upper gastrointestinal endoscopy. The prognostic factors were investigated using a step-by-step multivariate regression logistics, taking into account all the demographic, clinical and therapeutic parameters available.

RESULTS

The rate of symptom resolution was of 58% (2775 patients assessed in the intent-to-treat analysis). Failure was associated with the following factors: administration of non-steroid antiinflammatories before/during the study (Odds Ratio [OR] = 1.42, p = 0.015), initial severity of heartburn (OR = 1.37, p < 0.001), previous anti-secretory treatment (OR = 1.32, p = 0.001) and initial severity of acid regurgitation (OR = 1.18 p = 0.002). The relapse rate Owas of 26% (2214 patients assessed) with the following associated factors: previous anti-secretory treatment (OR = 1.98, p < 0.001), duration of GERD history (OR = 1.55, p < 0.001), previous administration of prokinetics (OR = 1.46, p < 0.001), distribution of GERD pain throughout the 24 hr period, body mass index and age of patients, with lower Odds Ratio; these last three factors inciting more reserve as to the results.

CONCLUSION

In the presence of these factors, assessment of GERD permits adaptation of the initial management and the eventual relay to a maintenance treatment in patients at risk of failure or relapse.