Survey On Symptom Spectrum, Sleep Quality And Quality Of Life In Patients With GERD

Introduction.Gastro-esophageal reflux disease(GERD) is defined as a disorder with upset symptoms and(or) complications caused by the reflux of gastro-duodenal contents into the esophagus.It was composed of three subgroups:reflux esophagitis(RE),non-erosive reflux disease(NERD) and Barrett Esophagus.GERD is easy to be misdiagnosised for the diversity and atypical of symptoms.GERD is frequent,long-term and chronic for some patients with impaired sleep quality and quality of life significantly.The etiology of GERD is diverse and the mechanism is primary the result of weaken on anti-reflux defend and attack of reflux contents on esophageal mucosa.For most patients with GERD,reflux events occur during both daytime and nighttime. Whereas daytime reflux events tend to be frequent but brief,reflux events that occur during sleep are comparatively less frequent but significantly longer.It was reported that the influence of frequent GERD during sleep was more obvious than daytime on sleep quality and life quality.The cause is likely to be associated with a marked prolongation of esophageal acid clearance and acid-mucosal contact time during sleep. The treatment of gastric acid suppression is a key way for GERD today.Proton pump inhibitors(PPIs) have been shown to be more superior to any other drug.PPIs can suppress gastric acid fully to reduce the damage of reflux contents on esophageal mucosa.Since the notion of health related quality of life(HRQoL) was introduced into the medicine field abroad in 1970s,many quality-of-life scales have been an increasingly used in the evaluation of efficacy on kinds of diseases,including the studies of GERD. For example,Pittsburgh Sleep Quality index scales on evaluating sleep quality as SF-36 and HRQoL on evaluating other generic and disease-specific quality-of-life scales as GERD-HQRL,WPAI-GERD and so on.The scales have been used to make a series of studies about demographic characteristics,clinical features,sleep quality and HRQoL on patients with GERD abroad.Nowadays,there are few researchers who have begun to study about this job in a few cities as Beijing.To try to compare the difference between the patients with RE and the patients with NERD on symptom spectrum,sleep quality,quality of life and present levels satisfaction by a questionnaire interview.To analyze main related symptoms in patients with GERD,especially,the relationship between nocturnal heartburn,reflux symptoms and sleep quality.To test the relationship between esophageal nocturnal acide exposure and sleep quality by combination object indicators(24 hours continuous pH monitoring data in patients with NERD).To analyze the impact of these disorders on quality-life. Finally,all patients were made comparison analysis on sleep quality,quality of life and presene levels of satisfaction before and after the treatment by a questionnaire interview so as to assess the efficacy of PPI on patients with GERD.Object and Methods:1.Object:Questionnaires were distributed to patients with endoscopies and(or) 24h continuous pH monitoring-proven GERD.All patients(total 221 GERD,191 RE, 30 NERD) were from department of gastroenterology Medical Institute Affiliated First Hospital of Zhejiang University and Zhejiang Taizhou Hospital from Dec in 2006 to Sep in 2008.Treatment proposal:formal dose PPI(Cap esomeprazola 20mg Bid) +hydrotalcite tables and(or) mosapride citrate tablets for 8 weeks.2.Methods:All enrolled patients were asked to finish three questionnaires. Including general data,symptoms,and levels of satisfaction,Pittsburgh Sleep quality index scales and SF-36 in Chinese.24h continuous pH monitoring was administered to the patients with GERD.The treatment group(66 cases) was asked to finish these questionnaires after 8 weeks' formal treatment again.Results:A total of 221 patients with GERD(142 males,79 females,ratio:1.797:1) entered the study.Mean age was 43.55±10.18 years old.Mean time was 20 weeks.Weight index was 22.973±2.671.Patients with RE were 191 cases.(grade A = 86 patients,grade B = 74 patients,grade C = 25 patients,grade D = 6 patients).Patients with NERD were 30 cases.1.There were no difference between RE group and NERD group on main related symptoms,sleep quality and present levels of satisfaction,but difference on some dimension of SF-36.2.The main related symptoms of patients with GERD were made up of heartburn (176 cases,79.6%),nocturnal heartburn(78 cases,35.3%),regurgitation(142 cases, 64.3%),nocturnal regurgitation(77 cases,34.8%),chest pain(59 cases,26.7%),upper abdominal(62 cases,28.1%),throat discomfort(66 cases,29.9%),cough(35 cases, 15.8%) and asthma(3 cases,1.4%).Pittsburgh Sleep quality index scores of patients with nocturnal heartburn and nocturnal regurgitation symptoms GERD are higher than those of patients without above symptoms(nocturnal heartburn,6.128±4.421 vs. 4.608±4.949,p＜0.05;nocturnal regurgitation,6.156±4.691 vs.4.604±4.809,p＜0.05). Make a relation test between 8 indexes of 24h continuous pH monitoring and Pittsburgh Sleep quality index scores in patients with NERD.There is statistical significance between Pittsburgh Sleep quality index scores(5.700±4.236) and the supine position reflux duration(56.033±66.874),the supine position long reflux times(1.900±1.769) and the longest supine position reflux time(23.200±23.316)(r = 0.518,0.424,0.515,p =0.003,0.020,0.004).It is tested that there is the relation between the esophageal nocturnal acid exposure and sleep quality in patients with NERD.8 dimensions of SF-36 are significantly decreased in patients with GERD(physical functioning 86.104±14.682,role-physical 64.335±38.034,bodily pain 63.172±21.031,general health 44.570±23.298,vitality 44.434±7.629,social functioning 69.869±19.682, role-emotional 63.303±36.808,mental health 72.561±16.024).Present levels of satisfaction in patients with GERD were satisfaction in 33 cases(14.9%),general in 89 cases(40.3%),unsatisfaction in 99 cases(44.8%).3.There is statistical significance between before and after 8 weeks formal treatment with PPI in 66 patients with GERD on infrequent of main-related symptoms excluding cough.(p＜0.05).There is statistical significance between before and after treatment on Pittsburgh Sleep quality index scores(5.152±5.027 vs.3.909±3.294,p＜0.05).On quality of life,bodily pain(61.212±19.379 vs.68.879±20.806),general health (41.136±22.232 vs.48.924±23.107),social functioning(69.909±19.270 vs. 74.349±16.245) and mental health(71.212±17.333 vs.76.242±12.130) are all different (p＜0.05).On present levels of satisfaction,there is statistical significance between before and after the treatment(satisfaction 9 cases vs.21 cases,general 29 cases vs.32 cases,unsatisfaction 28 cases 13 cases,p＜0.05).Conclutions:1.There are similarity between RE and NERD on symptoms spectrum and present levels of satisfaction.But difference existing in dimension of SF-36 is statistical significance,such as mental health.Difference in dimension of general health may exist.2.There are the relation of nocturnal heartburn,nocturnal regurgitation and sleep quality in patients with GERD.24h pH continuous monitoring show the relationship between the supine position reflux duration,the supine position long reflux times, the longest supine position reflux time and sleep quality in patients with GERD.3.The quality of life in patients with GERD decrease and their present levels of satisfaction are not high.PPI can improve clinical symptoms,sleep quality and life of quality and elevate the present levels of satisfaction in patients with GERD.