PMID- 23414966
OWN - NLM
STAT- MEDLINE
DCOM- 20130802
LR  - 20181202
IS  - 2213-0276 (Electronic)
IS  - 0755-4982 (Linking)
VI  - 42
IP  - 5
DP  - 2013 May
TI  - [Application of the recommendations of the conference of consensus in front of 
      symptoms ENT, respiratory or thoracic pains considered as due to a 
      gastroesophageal reflux disease].
PG  - e125-32
LID - S0755-4982(13)00010-9 [pii]
LID - 10.1016/j.lpm.2012.11.006 [doi]
AB  - AIMS: The primary objectives of this observatory were: (1) to assess the 
      prevalence of extradigestive symptoms (EDS) (asthma, pharyngeal pain, chronic 
      hoarseness, nocturnal breathlessness, chronic or nocturnal cough, non-cardiac 
      chest pain) which are suspected of being associated with gastro-oesophageal 
      reflux (GERD) in a population consulting in general practice; (2) to compare the 
      diagnostic and therapeutic approach adopted initially and at follow-up to the 
      recommendations of the French-Belgian Consensus Conference on adult GERD (1999). 
      METHODS: The survey was conducted among 578 general practitioners (GPs). All EDS 
      were investigated in patients (>/= 18 y.o.) consulting over 3 days. Only patients 
      considered a priori as having GERD related EDS were included in study. At each 
      visit (initial and at 1 and 4 months), the diagnostic and therapeutic approach 
      was analyzed, scored, and the GP's certainty regarding the accountability of GER 
      in the EDS rated using the visual analogue scale (VAS). The criteria used by GPs 
      to evaluate GER accountability as certain or doubtful were examined. RESULTS: Out 
      of 33,487 consulting patients, 14% presented EDS (cough: 6.7%; ENT symptoms: 
      7.7%; chest pain: 2.3%). Among patients presenting EDS, 22% (1063) were included 
      in the study based on suspicion of GERD, whereas 45% (481) had neither history 
      nor digestive symptoms typically associated with GERD. The diagnostic approach 
      did not vary whether the patient presented typical EDS associated symptoms (A+) 
      or not (A-): 83.7% of patients (A+) versus 86.5% (A-) immediately received acid 
      reflux treatment; 4.6% (A+) versus 7.9% (A-) underwent additional testing and 
      5.2% (A+) versus 4.4% (A-) were referred to a specialist. In 87% of cases, acid 
      reflux treatment included a proton pump inhibitor (PPI) (half-dose: 47.2%, 
      standard dose 50.3%, double dose 2.5%); in 8.1% of patients initial acid reflux 
      treatment included an H2 antagonist while in 3.2% of patients treatment included 
      prokinetic drugs. At 4 months of follow-up, GERD accountability was considered 
      certain in 74.7% of the patients included in the assessment (794/1063). The GPs 
      opinion was based on response to acid reflux treatment in 92% of cases, on 
      endoscopy in 6.7% of cases, on pH monitoring in 0.3% of cases and on a 
      specialist's opinion in 6% of cases. CONCLUSION: There is a considerable 
      difference between the recommendations of the French-Belgian Consensus Conference 
      on adult GERD and the practices observed in general medicine. The diagnostic and 
      therapeutic approaches were empirical with recourse to additional exams in less 
      than 10% of cases. The degree of certainty as to GERD accountability was based 
      primarily on response to PPI treatment.
CI  - Copyright (c) 2013 Elsevier Masson SAS. All rights reserved.
FAU - Vallot, Thierry
AU  - Vallot T
AD  - Clinique Claude-Bernard, 9, avenue Louis-Armand, 95120 Ermont, France.
FAU - Ducrotte, Philippe
AU  - Ducrotte P
FAU - Bour, Bruno
AU  - Bour B
FAU - Jacques, Jean-Paul
AU  - Jacques JP
FAU - Houcke, Philippe
AU  - Houcke P
FAU - De Korwin, Jean-Dominique
AU  - De Korwin JD
FAU - Pariente, Alexandre
AU  - Pariente A
FAU - Aygalenq, Philippe
AU  - Aygalenq P
FAU - Coudsy, Bogdana
AU  - Coudsy B
FAU - Carrois, Frederic
AU  - Carrois F
FAU - Ricci, Lea
AU  - Ricci L
FAU - Bruley des Varannes, Stanislas
AU  - Bruley des Varannes S
LA  - fre
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
TT  - Application des recommandations de la conference de consensus devant des 
      symptomes ORL, respiratoires ou des douleurs thoraciques consideres comme dus a 
      un reflux gastro-oesophagien.
DEP - 20130213
PL  - France
TA  - Presse Med
JT  - Presse medicale (Paris, France : 1983)
JID - 8302490
RN  - 0 (Antacids)
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Antacids/therapeutic use
MH  - Belgium
MH  - Chest Pain/etiology/*therapy
MH  - Drug Utilization/statistics & numerical data
MH  - Esophagoscopy/statistics & numerical data
MH  - Female
MH  - France
MH  - Gastric Acidity Determination
MH  - Gastroesophageal Reflux/*complications/diagnosis/drug therapy
MH  - Gastroscopy/statistics & numerical data
MH  - General Practitioners/*statistics & numerical data
MH  - Guideline Adherence/*statistics & numerical data
MH  - *Health Care Surveys
MH  - Histamine H2 Antagonists/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Otorhinolaryngologic Diseases/etiology/*therapy
MH  - *Practice Guidelines as Topic
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Prospective Studies
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Referral and Consultation/statistics & numerical data
MH  - Respiration Disorders/etiology/*therapy
MH  - Young Adult
EDAT- 2013/02/19 06:00
MHDA- 2013/08/03 06:00
CRDT- 2013/02/19 06:00
PHST- 2012/08/22 00:00 [received]
PHST- 2012/11/23 00:00 [revised]
PHST- 2012/11/27 00:00 [accepted]
PHST- 2013/02/19 06:00 [entrez]
PHST- 2013/02/19 06:00 [pubmed]
PHST- 2013/08/03 06:00 [medline]
AID - S0755-4982(13)00010-9 [pii]
AID - 10.1016/j.lpm.2012.11.006 [doi]
PST - ppublish
SO  - Presse Med. 2013 May;42(5):e125-32. doi: 10.1016/j.lpm.2012.11.006. Epub 2013 Feb 
      13.