Appropriate management of symptomatic GORD in primary care: has expert opinion changed between 2001 and 2005?

To determine current opinions of clinical experts on the appropriate management of symptomatic GORD in primary care, and to compare these opinions with those from a similar study conducted in 2001.

In 2001, a panel of 6 Belgian general practitioners and 6 gastroenterologists assessed the appropriateness of referral versus short-term anti-secretory medication for 768 different patient profiles, using the RAND/UCLA method. Applying a similar methodology, the same panel repeated these assessments in 2005. In addition, panellists were asked to indicate the preferred type of medication for all patient profiles.

Agreement between the results of 2001 and 2005 was high. Appropriateness ratings on referral versus medication were similar in 79% of patient profiles (weighted kappa value 0.77). Higher age and use of NSAIDs remained the dominant factors in favour of referral. Medication preference (not measured in 2001) showed marked differences between general practitioners and gastroenterologists. Gastroenterologists showed a higher preference for PPI high dose, whereas general practitioners more frequently chose for PPI low dose. H2-receptor antagonists were preferred in only few cases.

This study showed that expert opinion on the appropriateness of referral for endoscopy in patients with symptomatic GORD has only slightly changed over the past few years. Preferences for low and high dose PPIs varied between the two groups of physicians, which is most likely to be ascribed to the different patient populations seen in either primary or specialised care.