Sunday January 15, 2012
Coping with reflux
Diagnostic tool helps doctors and patients determine level of severity of acid reflux disease and assess response to the treatment.
ACCORDING to a recent Asia-wide survey on the impact of gastro-esophageal reflux disease (GERD) has on quality of life, about 60% of GERD patients feel unwell, avoid certain food and drink, feel tired and anxious due to GERD symptoms, while some 50% of sufferers are woken up by their symptoms at least once or twice a month.
Sleep disturbances notably affect patients’ productivity and leisure time, with 67% and 63% reporting significant to moderate impact on work productivity and leisure time, respectively.
The survey suggests that GERD sufferers underestimate how the disease can severely harm their quality of life, not realising it can lead to serious long-term health consequences. They only seek medical help when there is persistent pain and discomfort, with about half of them suffering symptoms for at least six months before consulting a doctor.
In Malaysia, an estimated 50% of the adult population suffer from at least one gastro-intestinal condition.
Misdiagnosis or under-diagnosis of GERD results in incorrect and ineffective treatment. To help doctors and their patients, AstraZeneca, a research-based biopharmaceutical company, has developed an easy and effective diagnostic tool, known as GERDQ, which doctors can use in clinics.
GERDQ is a six-item questionnaire that helps identify patients with GERD. Patients are asked to report frequency of symptoms over the past seven days. Answers are compiled according to a scale of options and are scored accordingly.
The symptom scores and impact score are used to compile a GERDQ score, which the physician can use to make an initial diagnosis and appropriate treatment recommendations. GERDQ can also be used to monitor the effect of therapy on patients’ symptoms and quality of life over time.
In a local study pioneered and led by Prof Datuk Dr Goh Khean Lee among 30 medical practitioners in Malaysia, GERDQ has shown to be a highly convenient and useful tool to diagnose and assess response to the treatment of GERD.
Prof Goh, who is head of gastroenterology and hepatology at University of Malaya, said, “Many patients are unaware that they have symptoms of GERD, and that the disease can have serious consequences if left untreated. More than 80% of doctors said that GERDQ was reliable and would consider it for future diagnosis.
“This outcome is encouraging as the tool will help us more accurately diagnose the severity of GERD, and prescribe the best therapy to manage it. I strongly recommend that patients and their doctors take a few minutes to complete the questions. It’s very simple, but the results are invaluable and will help both patient and doctor,” added Prof Goh, who has published several important articles in the area of GERD and is a key member of the Asian Pacific Consensus on GERD in 2003 and 2006 and the International Consensus on NERD (non-erosive reflux disease) in 2008.
GERD is a condition that develops when the reflux of gastric content causes troublesome symptoms or complications. The Montreal Definition and Classification of GERD includes a patient-centred approach independent of endoscopic findings, as well as the recognition of laryngitis, cough, asthma and dental erosions as possible GERD syndromes.
GERD can affect anyone, at any age, often times young adults in the prime of their lives. It can lead to more serious health problems, such as breathing difficulties, bleeding and scarring of the oesophagus, as well as oesophageal cancer in a very small minority of patients.
Prof Goh explained that many people confuse symptoms of GERD with other gastroenterological conditions, which often leads to a wrong diagnosis.
“Because symptoms are not well understood, many people tend to confuse GERD symptoms with those of other more common ailments. These can range from the mild, say indigestion, to the serious, such as heart attack. It’s important that people learn to recognise the signs of GERD so they can receive proper treatment.
“People who believe that indigestion is the cause of their discomfort will invariably treat it with antacids, without first checking if there is an underlying condition. Some over-the-counter treatments may do more harm than good, so it is very important that people seek advice from their doctor before trying to self-medicate,” Prof Goh stated.
“The discomfort of heartburn occurs in the chest region, so some people believe that a heart attack is imminent. Once that is ruled out, GERD should be considered as a diagnosis as many patients with GERD present with what is known as non-cardiac chest pain. For obvious reasons, this can be dangerous, so we do encourage patients to be aware of the similarities and differences in the symptoms of heart attack and GERD.”
Living with GERD
GERD patients experience painful symptoms of this chronic disease on a daily basis, casting a shadow over all aspects of their everyday activities and disrupting interaction with friends and family.
According to Dr Tan Huck Joo, consultant gastroenterologist and past president of the Malaysian Society of Gastroenterology and Hepatology, patients should not let GERD symptoms interrupt their daily tasks. “There is no need to suffer in silence. Get advice from your doctor so that both of you have a better understanding of the severity of your condition. Only then can you get personalised treatment for your GERD,” said Dr Tan, who is also a committee member of the Malaysian Society of Gastroenterology and Hepatology.
Patients with severe GERD may be prescribed drugs known as proton pump inhibitors (PPIs), such as esomeprazole, which essentially block acid production and its flow into the oesophagus.
Stomach acid is harsh and the lining of the oesophagus is delicate. GERD patients may experience heartburn when acid backs up (refluxes) into the oesophagus and if acid reflux continues without being treated, it can cause tissue damage over time in the lining of the oesophagus.
This potentially serious condition is called erosive oesophagitis, but with effective treatment, the erosion can be healed.
If left untreated, the risk of oesophageal cancer and Barrett’s oesophagus (changes in the lining of the oesophagus that predispose patients to malignancy) is significantly increased.
PPIs allow time for damaged oesophageal tissue to heal in about four and eight weeks. It is advisable for patients to take PPIs one hour before breakfast because they will be at their peak levels in the body after a meal when the acid is being created.
Although there are other treatments available, they may not be as effective. These include H2 blockers and antacids.
In fact, high dose PPI has been used as a diagnostic test for GERD and also as treatment for extra-oesophageal symptoms of GERD.
Help for GERD sufferers
Early detection and treatment of GERD can significantly improve patients’ quality of life, enabling them to maintain their careers, experience the joys of family life and spend time with family and friends without feeling drained, tired and physically incapable of dealing with the stress associated with the disease.
“There are a few ways to treat GERD, but people should get properly diagnosed by their doctors. Only then can the doctor prescribe a treatment regimen that is suitable to you. We consider various factors, including your own health record, family history, lifestyle, and other risk factors, such as smoking. Furthermore, we now have GERDQ to help us diagnose and assess response to treatment.
“I would like to encourage anyone who experiences consistent symptoms related to GERD to seek advice from their doctor. Make your appointment today so that you can continue to enjoy your quality of life without painful and disruptive GERD symptoms,” added Dr Tan.