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The Impact of Nocturnal Symptoms Associated With Gastroesophageal Reflux Disease on Health-Related Quality of Life
Christina Farup, MD;
Leah Kleinman, DrPH;
Sheldon Sloan, MD;
Dara Ganoczy, MPH;
Elsbeth Chee, ScD;
Clara Lee, MPH;
Dennis Revicki, PhD
Arch Intern Med. 2001;161:45-52.
Background Two types of reflux episodes have been identified: upright or daytime
and supine or nocturnal. The population-based prevalence of symptoms of nocturnal
gastroesophageal reflux disease (GERD) and the impact of those symptoms on
health-related quality of life (HRQL) have not been established.
Methods A national random-sample telephone survey was conducted to estimate
the prevalence of frequent GERD and nocturnal GERD-like symptoms and to assess
the relationship between HRQL, GERD, and nocturnal GERD symptoms. Respondents
were classified as controls, subjects with symptomatic nonnocturnal GERD,
and subjects with symptomatic nocturnal GERD. The HRQL was assessed using
the Medical Outcomes Study Short-Form 36 Health Survey (SF-36).
Results The prevalence of frequent GERD was 14%, with an overall prevalence
of nocturnal GERD of 10%. Seventy-four percent of those with frequent GERD
symptoms reported nocturnal GERD symptoms. Subjects with nonnocturnal GERD
had significant decrements on the SF-36 physical and mental component summary
scores compared with the US general population. Subjects reporting nocturnal
GERD symptoms were significantly more impaired than subjects reporting nonnocturnal
GERD symptoms on both the physical component summary (38.94 vs 41.52; P<.001) and mental component summary (46.78 vs 49.51; P<.001)
and all 8 subscales of the SF-36 (P<.001). Subjects with nocturnal
GERD demonstrated considerable impairment compared with the US general population
and chronic disease populations. Subjects with nocturnal GERD had significantly
more pain than those with hypertension and diabetes (P<.001)
and similar pain compared with those with angina and congestive heart failure.
Conclusions Nocturnal symptoms are commonly experienced by individuals who report
frequent GERD symptoms. In addition, HRQL is significantly impaired in those
persons who report frequent GERD symptoms, and HRQL impairment is exacerbated
in those who report nocturnal GERD symptoms.
From Janssen Pharmaceutica, Inc, Titusville, NJ (Drs Farup and Sloan);
Center for Health Outcomes Research, MEDTAP International, Inc, Bethesda,
Md (Drs Kleinman and Revicki and Ms Ganoczy); and Innovative Medical Research,
Inc, Towson, Md (Dr Chee and Ms Lee). Drs Farup and Sloan are employees of
Janssen Pharmaceutica, Inc, and own stock in Johnson & Johnson, the parent
company of Janssen Pharmaceutica, Inc.
Reprints: Leah Kleinman, DrPH, MEDTAP International, Inc, 2101 Fourth
Ave, Suite 2260, Seattle, WA 98121 (e-mail: Kleinman{at}MEDTAP.com).
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