Management of gastroesophageal reflux disease by primary care physicians and gastroenterologists: A prospective study of patients’ records

• Published in: Gastroentérologie clinique et biologique 2008-12, Vol.32 (12), p.995-1000
• Main Authors: Bretagne, J.-F., Honnorat, C., Richard-Molard, B., Soufflet, C., Barthélemy, P.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Esophagus; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - therapy; Humans; Male; Medical Records; Medical sciences; Middle Aged; Other diseases. Semiology; Primary Health Care; Prospective Studies
• ISSN: 0399-8320
• DOI: 10.1016/j.gcb.2008.05.020

We previously compared the perceptions and practices of primary care physicians (PCP) and gastroenterologists (GE) in the management of gastroesophageal reflux disease (GORD), but the data were only declarative statements. The aim of the present study was to analyze the respective management of GORD by PCP and GE on the basis of patients’ records, and to look for any discrepancies between the declared and actual practices in both groups of physicians in the management of GORD. A representative sample of French physicians was asked to enroll two consecutive patients with frequent and typical symptoms of GORD into a prospective observational survey. A total of 136 PCP and 91 GE participated in the survey and enrolled 271 and 182 patients, respectively, with frequent GORD symptoms (453 patients in total). Patients consulting GE were slightly younger, and had waited longer before arranging a consultation despite having symptom severity and impact on daily life similar to those visiting PCP. Most patients enrolled by GE had undergone upper GI endoscopy (95% versus 64% from PCP, P < 0.01). In both groups of physicians, recourse to endoscopy for their patients was more frequent than they estimated. Prescription therapies for GORD were usually Proton Pump Inhibitors (PPI) in both groups of physicians and were in keeping with the declared findings. Despite differences between patients’ characteristics, the management of frequent GORD was similar by both groups of physicians. The reasons why both groups of physicians underrated their actual recourse to endoscopy for their patients warrant further investigation. Dans une étude précédente, nous avions déjà comparé la perception et les pratiques des médecins généralistes (MG) et des gastro-entérologues (GE) dans la prise en charge du reflux gastro-œsophagien (RGO), mais il s’agissait des données déclaratives. Le but de cette étude a été, à travers l’analyse de dossiers patients, de rechercher des différences de pratiques entre les deux groupes de praticiens. Il était demandé à un échantillon représentatif de médecins français d’inclure deux patients consécutifs ayant des symptômes fréquents et typiques de RGO dans une cohorte prospective observationnelle. Au total, 136 MG et 91 GE ont participé à l’étude et ont inclus un total de 453 cas, respectivement 271 et 182 cas. Les patients consultant les GE étaient un peu plus jeunes, et ils avaient attendu plus longtemps avant de consulter malgré une sévérité symptomatique et