Real world clinical practice patterns in nocturnal GERD management: insights from nationwide RELIEF survey.

Abstract

Background and objectives: Nocturnal symptoms of GERD interfere with daytime functioning, work, and social activities, thereby negatively affecting health-related quality of life. Therefore, the present survey aimed to evaluate the clinical practice patterns regarding the management of nocturnal GERD in India.

Methods: A digital questionnaire-based nationwide RELIEF survey was conducted among health care practitioners (HCPs) with gastroenterology practice across India. Physicians voluntarily responded to the survey questionnaire consisting of 24 questions based on their clinical experience. Following the collection of completed questionnaires, data were reviewed and analyzed.

Results: Of the 500 HCPs who were approached, 498 completed the study. GERD contributed to > 30% of patient burden every month. According to 25.30% of HCPs, 21-30% of patients with GERD complain of nocturnal symptoms. The most common risk factors in patients with nocturnal GERD were late-night meals (67.67%), followed by smoking (51%), BMI > 25 kg/m² (50.20%), and a high-fat diet (50.40%). Most HCPs (83%) relied on symptoms and medical history to diagnose nocturnal GERD. A single-dose proton pump inhibitor (PPI) regimen was the most preferred treatment, reported by 31.53% of HCPs, with esomeprazole preferred by 54% of physicians. Efficacy (58.03%), minimum or no drug-drug interactions (29.92%), and cost (22.49%) are the important aspects for choosing a PPI. HCPs (63.18%) opted for 4-8 weeks of PPI therapy to achieve resolution of nocturnal GERD symptoms, followed by 3-6 months of maintenance therapy (57.95%). Common causes of non-adherence to PPIs, as reported by 80.72% of HCPs, were stopping treatment once symptoms improved (53.01%), cost (39.56%), and incomplete disease awareness (29.92%). Most of the HCPs (42.77%) reported no side effects with the use of PPIs.

Conclusion: The survey highlighted key insights into managing nocturnal GERD in India, with nearly one-fourth of GERD patients reporting nocturnal symptoms like heartburn and regurgitation, emphasizing the need for lifestyle modifications and suitable pharmacological interventions. The management strategy primarily includes PPI therapy, with esomeprazole being the preferred choice for nocturnal GERD.