Introduction
While the global prevalence of GERD ranges from 5% to 25%, in Sri Lanka, it is slightly higher at 25.3%. There are no Sri Lankan guidelines for management of GORD despite it been a relatively common condition.
However, there is a lack of studies in Sri Lanka documenting the current management practices for GERD among doctors both primary and specialized.
Aims & Methods
This study aims to give an insight about the Sri Lankan doctor’s point of view in managing GERD.
A self-administered questionnaire designed to gather information on medication prescription, lifestyle advice given, investigations, and personal experiences and beliefs was used. MBBS doctors working as primary care doctors, consultant general physicians/ general surgeons/ gastroenterologists as well as trainees in the fields, attached to the National Hospital of Sri Lanka, Colombo South Teaching Hospital, Colombo North Teaching Hospital, and the College of General Practitioners, Sri Lanka were approached consecutively.
Data analysis was conducted using SPSS-28.
Results
Of the 100 participants recruited, 57 were male while the average age was 35 years. The average duration of practice as a doctor was 11 years, ranging from 1 to 50 years. A significant proportion of doctors reported personally experiencing reflux and regurgitation (n=62, 62.0%).
In the first presentation of heartburn or reflux, the majority of doctors prescribed proton pump inhibitors (PPIs) (n=92,92.0%), followed by domperidone (n=67,67.0%), antacid syrups (n=42, 42.0%), H2 receptor blockers (n=37, 37.0%), antacid tablets (n=27,27.0%), antidepressants and anxiolytics (n=11,11.0%). Prescription at the second presentation showed a similar trend except for H2 receptor blockers taking precedence while only 3 doctors prescribed triple therapy. Only 46.0% advised the patients to come for a follow-up, and the mean follow-up period was 2 weeks, with n=88,88.0% of the patients presenting.
Most doctors referred/ utilized upper gastrointestinal (GI) endoscopy (n=96,96.0%), while upper GI manometry (n=13,13%) and pH impedance studies (n=4,4.0%) were referred at specialist level.
Most doctors reported advising their patients (n=88,88.0%) on lifestyle changes, such as avoiding food that causes GERD symptoms (n=91,91.0%), weight loss (n=71,71.0%), reducing mental stress (n=70,70.0%), and other lifestyle modifications. Spicy food (n=86,86.0%), oily food (n=93,93.0%), wheat-based food(n=50,50.0%), and bread (n=52,52.0%), were the types of food most commonly advised against.
The majority 73% of doctors co-prescribed PPIs for patients on multiple other medications and 36% co-prescribed PPIs when NSAIDs were prescribed (n=64,64.0%).
Only 52.0% were satisfied with their management while 19% believed that anti-reflux surgery was a good option for managing GERD.
Conclusion
According to this study a majority of physicians prescribe proton pump inhibitors (PPIs) as the first-line treatment for GERD, followed by other medications such as domperidone and antacids. Lifestyle modifications, including dietary changes and stress reduction, are commonly advised. Upper GI endoscopy is the most preferred investigation method. Despite advising patients to avoid wheat and bread, many physicians report patients experiencing symptoms from these foods only sometimes or less. Overall, physicians are generally satisfied with their management of GERD and do not consider surgery as a treatment option.
Education programs and seminars on the management of GERD is recommended to ensure optimal patientcare.