BACKGROUND:Little is known about the distinctive characteristics of subjects with frequent (at least weekly) and occasional gastro-oesophageal reflux symptoms.AIM:To compare the characteristics and disease management of subjects complaining of at least weekly and less frequent gastro-oesophageal reflux symptoms.METHODS:Population-based postal survey carried out in France in 2003 among a representative sample of 8000 subjects.RESULTS:The prevalence of frequent and occasional gastro-oesophageal reflux symptoms was 7.8% and 23.4%, respectively. Compared to subjects with occasional gastro-oesophageal reflux symptoms, those with frequent symptoms were older, suffered from more severe symptoms and felt greater impact on daily living, despite a slightly shorter duration of symptoms. These subjects more often sought medical advice. Most of them had treated the last episode of symptoms primarily with a proton-pump inhibitor and less often with antacids/alginates. The degree of treatment satisfaction was lower in subjects with frequent gastro-oesophageal reflux symptoms, in relation to a more frequently observed persistence of symptoms irrespective of the medication used except for proton-pump inhibitors.CONCLUSIONS:This survey suggests that subjects complaining of frequent or occasional gastro-oesophageal reflux symptoms constitute two distinctive groups. Despite greater healthcare use, the former group shows a lower level of satisfaction with disease management. Nevertheless, a substantial subset of subjects with occasional symptoms also complained of impaired health-related quality of life and sought health care.

Aims. To obtain data on routine care of gastro-oesophageal reflux disease by French gastroenterologists. Patients. Five thousand and forty-five adults with gastro-oesophageal reflux disease. Methods. Patients were recruited by a representative sample of 598 French gastroenterologists. A full disease history, with treatments given/investigations undertaken, was obtained from all patients. The patients’ expectations with regard to the improvement of the symptoms’ control and the corresponding assessments made by the gastroenterologists were recorded on a 4-point scale. Results. The mean time since diagnosis was approximately 4 years. The most commonly presented symptom was heartburn (79% of patients). A total of 3735 patients (74%) underwent endoscopy because of gastro-oesophageal reflux disease. Erosive oesophagitis was present in 38% and Barrett's oesophagus in 8%. Medical therapy for gastro-oesophageal reflux disease was prescribed in 92% of patients, of whom 86% received proton pump inhibitors. Lifestyle advice was given to 73% of patients. Overall, 84% of patients and 72% of physicians expected ‘highly’ or ‘moderately’ improved control of gastro-oesophageal reflux disease. Gastroenterologists underrated the need for improvement of the symptoms’ control as expressed by ‘de novo’ as well as ‘previously diagnosed’ patients. Conclusions. This study provides cross-sectional data on the management of gastro-oesophageal reflux disease by gastroenterologists in France. Most patients have high expectations of an improvement in their management, but gastroenterologists generally underrate these expectations.

Introduction: Le but de cet observatoire a été d’évaluer le motif, le mode deréalisation, les résultats de l’endoscopie oeso-gastro-duodénale (EOGD) dans la prise en charge du reflux gastro-ésophagien (RGO) auprès de Gastro-Entérologues (GE) exerçant en secteur libéral. Patients et Méthodes: L’observatoire transversal mis en place en France en octobre 2002, a impliqué 480 GE du secteur libéral qui devaient recruter 4 patients (Pts) adultes présentant des symptômes typiques ou non de RGO pour lesquels une EOGD était réalisée ou programmée le jour de la consultation. Résultats: Mille sept cent soixante-dix-sept Pts (âge: 52 ± 16 ans, 54% hommes, BMI: 25,5, tabac: 18,5%) ont été inclus. Ils étaient adressés par le médecin généraliste (MG) (62%), un spécialiste (8%) ou consultaient en accès direct (30%). Le RGO était connu pour 65% des Pts et, dans ce cas, la médiane d’ancienneté du RGO était de 3 ans. Le diagnostic initial avait été posé par le MG (57%), le GE (40%), autre (3%). Lors de la consultation du jour, les symptômes de pyrosis, de douleurs épigastriques, de régurgitations acides, de dysphagie étaient présents dans respectivement 77%, 52%, 47%, 10% des cas; 74% des Pts avaient des symptômes quotidiens. Cinquante pour cent des Pts étaient traités et 24% suivaient des règles hygiéno-diététiques. Les motifs de l’EOGD était: endoscopie initiale (73%), modification des symptômes (14%), contrôle de cicatrisation (6%), signes extra-digestifs (4%), surveillance d’un endobrachy-ésophage (EBO, 3%). L’EOGD était réalisée sans anesthésie générale (AG), avec AG ou sédation, dans respectivement 56%, 36%, 8% des cas. L’ EOGD montrait des érosions chez 54% des Pts (classification de Los Angeles A: 48%, B: 37%, C: 11%, D: 4%), une hernie hiatale (53%), un EBO (7%), une sténose (2%), un adénocarcinome (0,5%, n = 9). Des biopsies ont été réalisées chez 506 Pts (29%) pour recherche de H. pylori (n = 352, 70%) et EBO (n = 89, 17,6%). La recherche de H. pylori. était positive dans 30% des cas. Les biopsies sur EBO ont montré une dysplasie dans 9% (n = 8) des cas. A l’issue de la consultation, 87% des Pts recevaient un traitement (83% IPP, 8% prokinétique, 7% anti-acide). Le retentissement du RGO sur la qualité de vie était moyenne à forte pour 89% des Pts. Quatre-vingt-six pour cent des Pts étaient satisfaits de leur prise en charge, mais pour 55% des GE, le RGO pourrait être mieux contrôlé. Conclusion: Dans la prise en charge du RGO au sein d’une population consultant un GE, l’EOGD était principalement motivée pour le diagnostic initial, et dans plus de la moitié des cas, une oesophagite était diagnostiquée. Quand l’EBO était biopsié, une dysplasie était retrouvée dans 9% des cas.

Parmi les patients souffrant de R G O, la proportion de ceux ne consultant pas un médecin, est mal connue en France. Une enquête de population sur le RGO a donc pour objectif de mieux préciser les caractéristiques de cette pathologie, les modalités de sa prise en charge et le degré de satisfaction qui en découle.

Objective To investigate the prognostic factors of symptom resolution or failure and relapse in patients presenting with symptomatic gastroesophageal reflux (GERD) and treated in the usual conditions of primary care. Method Controlled, non-comparative study consisting of a 4-week treatment phase (omeprazole 10 mg/day) and a 12-week follow-up phase. Initial symptom resolution was defined as no heartburn in the week preceding the assessment at the end of treatment, Following initial symptom resolution, relapse was defined as the occurrence of moderate or severe heartburn and/or acid regurgitation, and/or ingestion of antisecretory agents or prokinetics, or the existence of symptoms justifying upper gastrointestinal endoscopy. The prognostic factors were investigated using a step-by-step multivariate regression logistics, taking into account all the demographic, clinical and therapeutic parameters available. Results The rate of symptom resolution was of 58% (2775 patients assessed in the intent-to-treat analysis). Failure was associated with the following factors: administration of non-steroid anti-inflammatories before/during the study (Odds Ratio [OR] = 1.42, p = 0.015), initial severity of heartburn (OR = 1.37, p < 0.001), previous anti-secretory treatment (OR = 1.32, p = 0.001) and initial severity of acid regurgitation (OR = 1.18 p = 0.002). The relapse rate Owas of 26% (2214 patients assessed) with the following associated factors: previous anti-secretory treatment (OR = 1.98, p < 0.001), duration of GERD history (OR = 1.55, p < 0.001), previous administration of prokinetics (OR = 1.46, p < 0.001), distribution of GERD pain throughout the 24 hr period, body mass index and age of patients, with lower Odds Ratio; these last three factors inciting more reserve as to the results. Conclusion In the presence of these factors, assessment of GERD permits adaptation of the initial management and the eventual relay to a maintenance treatment in patients at risk of failure or relapse.

OBJECTIVE:To evaluate the effect of eradication treatment of Helicobacter pylori and the influence of H. pylori status on the incidence of gastrointestinal (GI) events in rheumatic patients receiving longterm conventional nonsteroidal antiinflammatory drug (NSAID) therapy combined with omeprazole.METHODS:Patients (n = 919) requiring longterm NSAID therapy entered this multicenter, open label, parallel group study. H. pylori positive patients were randomized to receive either eradication therapy (omeprazole 20 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid for 7 days) or no therapy. Both these groups and the H. pylori negative patients were given omeprazole, 20 mg once daily, along with NSAID for the study duration (5-8 weeks). Treatment failure (primary outcome variable) was defined as the occurrence of severe GI event (symptomatic ulcer, bleeding, perforation) or dyspepsia leading to discontinuation of NSAID therapy, unscheduled consultation, or upper GI tract endoscopy.RESULTS:Treatment failure was recorded in 9/294 (3.06%) infected patients receiving eradication therapy, 8/219 (3.65%) infected patients receiving omeprazole alone, and 5/391 (1.28%) H. pylori negative patients (p > 0.05). H. pylori eradication did not appear to influence the incidence and severity of dyspeptic symptoms in infected patients.CONCLUSION:Our results do not support the use of H. pylori eradication therapy in rheumatic patients receiving conventional NSAID along with omeprazole.

BACKGROUND:Helicobacter pylori eradication rates in France after therapy with omeprazole, amoxicillin and clarithromycin are among the lowest in Europe. This study evaluated alternative eradication regimens.METHODS:Helicobacter pylori-positive patients (n=323) with non-ulcer dyspepsia were randomized to receive one of four 1-week regimens consisting of omeprazole, 20 mg b.d., plus either: amoxicillin, 1000 mg b.d., and clarithromycin, 500 mg b.d. (OAC); bacampicillin, 1200 mg b.d., and clarithromycin, 500 mg b.d. (OBC); clarithromycin, 250 mg b.d., and metronidazole, 500 mg b.d. (OCM); or amoxicillin, 1000 mg b.d, and azithromycin, 500 mg on day 1 and 250 mg on days 2-5 (OAAz). Eradication was confirmed by urea breath test 4-6 weeks after treatment. Susceptibility testing was performed in the case of eradication failure.RESULTS:The eradication rate with OAAz was 38% (95% CI, 25.6-49.4) on intention-to-treat analysis, which was lower (P < 0.05) than with the other regimens [OCM, 61% (50.0-72.8); OBC, 65% (54.0-76.5); OAC, 72% (61.8-81.8)]. Of the strains isolated following treatment failure with OAC, OBC or OCM, 84% were clarithromycin resistant.CONCLUSIONS:OAC remains the reference treatment for H. pylori eradication in France, although bacampicillin offers a useful alternative to amoxicillin. Susceptibility testing should be considered after unsuccessful eradication therapy.

Adverse cardiac events have been reported in patients receiving cisapride.We conducted an independent case review of all spontaneous adverse event reports of serious ventricular arrhythmias (SVAs) and QT prolongation (t QT) and of clinical events possibly due to SVAs in patients treated with the prokinetic agent, classifying cases by confidence in diagnosis (dx) and presence of cofactors.We assigned confidence in dx conservatively (erring on side of dx of LQTS), and decisions were made solely by us, without company involvement.Of 471 cases reported worldwide from December 1990 through March 1999, 327 (69%) cases of LQTS or t QT were identified; in 83 (18%) no LQTS or t QT was identified and in 61 (13%) there were insufficient data to assess LQTS.In most of the 327 LQTS or t QTcases, we had high (122,51% ofLQTS cases) or medium (77, 32%) confidence in LQTS dx; 86 (26%) had only t QT.Recognized cofactors were present in 222 (68%) t QT or LQTS cases.The percentage of LQTS cases with cofactors rose with confidence level (P<.OOI): Recognized cofactors were present in 100 (82%) cases with high confidence LQTS and 54 (70%) with medium confidence, versus 14 (33%) with low confidence.The most common recognized cofactors in t QT or LQTS were coadministration of medications that increase cisapride levels by inhibiting cytochrome P450 3A4 (97 cases, 44%), electrolyte disturbances (69, 31%), and concomitant QT prolonging drugs (54, 24%).Of cases in which cytochrome P450 3A4 inhibitors were coadministered, clarithromycin, erythromycin, or fluconazole, or a combination of these drugs, was administered in 79 (81%).Other medical conditions cited as contraindications in labeling (eg, heart failure) were uncommon sole cofactors (45,14%).Of 34 (14%) LQTS cases without cofactors, 9 (4%) were designated high-confidence.Most patients with high confidence dx LQTS and no cofactors or other labeled conditions had complex medical histories.We conclude that in the vast majority of cases of LQTS in patients receiving cisapride, recognizable and often preventable cofactors are present and that LQTS risk diminishes when this drug is used appropriately.Additional data and analysis from this ongoing study will be presented.

Background and Aim: NSAlD-induced lesions of the gastrointestinal tract and NSAlD-related ileal chronic enteropathy are well-known.Several cases of acute NSAlD-induced colitis have been reported but the general role of NSAlD recent intake as a risk factor for acute diarrhea has not been studied so far.The aim of our study was to determine whether the risk of acute diarrhea is increased by NSAlDs in a prospective series of cases of acute diarrhea seen by general pratitioners in France and serious enough to require a stool culture.Patients and Methods: Two hundred and eighty-five consecutive patients with acute diarrhea seen by Sentinelles practitioners between December 1998 and July 1999 were enrolled in the study.Information about exposure to NSAlDs within the 4-month period preceding the onset of diarrhea was collected by the pratitioners.The relative risk of NSAlD-related acute diarrhea was estimated using the case-crossover design (in which each case is its own control) by comparing the NSAlD exposition within the risk period preceding the onset of diarrhea with the NSAlD exposition within the first part of the 4-month observation period.Three risk periods (1, 3 or 6 days preceding the onset of diarrhea) were considered.Results: The relative risk of acute diarrhea related to recent NSAlD intake was increased for all three risk periods.The relative risk and its confidence interval was 2.9 [1.4 -6.1] for the one-day risk period, 2.7 [1.4 -5.1] for the 3-day risk period, and 3.3 [2.0 -5.4] for the 6-day risk period.Conclusion: Our results first demonstrate that recent NSAlD intake increases the risk for acute diarrhea.We suggest that acute diarrhea seen in general practice and not only acute colitis seen by gastroenterologists should be considered as a potential complication of recent NSAlD intake.

Previous studies have shown that Helicobacter pylori adheres to gastric foveolar cells (secreting neutral mucins) but not to metaplastic cells (secreting acid mucins).Sulfomucin secretion characterizes "type III" ("incomplete" or "colonic") metaplasia, and such lesions are associated with an increased risk of gastric cancer.In this study the influence of sulfomucin secretion on H. pylori colonization and adhesion to metaplastic cells was assessed.Gastric biopsies of 230 patients from Narino, Colombia, with histologicailyproven H. pylori infection and intestinal metaplasia were analyzed.Sulfated mucins and H. pylori were visualized using a new technique combining high-

Objective: The main objective of the study was to evaluate the efficacy of a treatment regimen combining several doses of omeprazole in patients with gastro-oesophageal reflux, with or without oesophagitis. Patients and method: 231 patients with symptoms of isolated reflux or associated with non-confluent (grade I) oesophagitis were treated with 20 mg of omeprazole per day for 2 months; after 2 months, responding patients then received 10 mg of omeprazole per day for another 4 months (arm A). 196 patients with confluent or circumferential oesophagitis (grades 2-3) were initially treated for 4 months with 20 or 40 mg of omeprazole per day. The dosage was adjusted after 2 months according to the persistence of symptoms. After 4 months, in cured and relieved patients, the dose of omeprazole was reduced to 10 mg or 20 mg depending on the effective dosage during the initial treatment phase for another period of 8 months (arm B). Reflux symptoms were evaluated by a score (1-4) and the Spechler index, and oesophagitis was evaluated according to the Savary-Miller classification. Results: 1) Arm A: 96 % of patients treated with 20 mg of omeprazole were relieved after 2 months of treatment. This rate was maintained at 92 % after another 4 months of treatment with 10 mg of omeprazole. 2) Arm B: 94 % of patients were healed after 4 months of treatment with omeprazole. During the maintenance phase, 89 % of patients were treated with 10 mg of omeprazole. The dosage reduction after induction treatment allowed maintenance of endoscopic and symptomatic remission in 70 % of patients. Conclusion: The extensive dose-antisecretory effect relationship of omeprazole allows adaptation of the dose prescribed to each patient according to the objective defined (symptomatic relief and/or healing).