CPD: Is a proton pump inhibitor (PPI) the GP’s gastroscopy?

Abstract

Gastro-oesophageal reflux disease (GORD) and dyspepsia are two of the most common gastrointestinal conditions seen in general practice. GORD symptoms have been shown to occur on a weekly basis in 20% of a Minnesota, USA population.1 In a Swedish study of a random sample of 1 000 adults, 45% reported reflux symptoms in the preceding three months.2 The prevalence of GORD has increased markedly over the past few decades, with possible causes being increased fat intake, obesity, the use of oestrogens and smoking. Dyspepsia prevalence is estimated at 25-40%, accounting for about 2-5% of GP visits. Only one in four patients consults a GP about the symptoms.3 The similarities in the clinical picture of GORD and functional dyspepsia are further complicated by the overlap between these conditions. Sixty percent of patients experiencing reflux symptoms of heartburn and regurgitation will demonstrate no endoscopic abnormalities.4 These patients are referred to as having non-erosive reflux disease (NERD). Females predominate in the overlap group and tend to be about one decade younger than their GORD counterparts. This overlap is not surprising, given the high prevalence rates of these conditions. Before deciding on a strategy to investigate or treat empirically, one needs to make a working diagnosis. The subsequent management pathway then becomes easier for both doctor and patient. This review will attempt to define, for the general practitioner, the place of the “PPI test in these conditions. (SA Fam Pract 2005;47(2): 24-28)