Impact of gastro-oesophageal reflux disease on work productivity despite therapy with proton pump inhibitors in Germany
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Impact of gastro-oesophageal reflux disease on work productivity despite therapy with proton pump inhibitors in Germany

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7 pages
English

Description

Gastro-oesophageal reflux disease (GERD) is a common disorder with consequences for the patient's health-related quality of life (HRQoL). In Germany, few data are available on the impact of GERD on work-related productivity. Aim To study the impact of GERD on work productivity despite proton pump inhibitor (PPI) therapy and the association between productivity and symptom duration, severity, and HRQoL. Methods Retrospective data from randomly selected patients with chronic GERD symptoms, treated by office-based general practitioners or general internists with routine clinical care, were analyzed together with information from self-administered instruments assessing work productivity (WPAI-GERD), symptoms (RDQ), and HRQoL (QOLRAD). Results Reduced productivity was reported by 152 of 249 patients (61.0%), although 89.5% of them were treated with PPI. The reduction in work productivity was 18.5% in all patients and 30.3% in those with reduced productivity. Patients with impaired productivity showed a significantly lower HRQoL and more-severe symptoms of reflux disease. In all patients, the mean sick leave attributable to reflux symptoms was 0.6 hours in the previous seven days and 1.4 work days in the previous three months. Conclusion GERD has a substantial impact on work productivity in Germany, even in patients receiving routine clinical care and PPI therapy.

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Publié le 01 janvier 2010
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Langue English
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7.Gross_Umbruchvorlage17.03.1011:09Seite124124EuRoPEanJouRnalofMEDIcalREsEaRcHMarch30,2010
EurJMedRes(2010)15:124-130©I.HolzapfelPublishers2010

I
MPactof
G
astRo
-
oEsoPHaGEal
R
Eflux
D
IsEasEon
W
oRk
P
RoDuctIvIty
D
EsPItE
t
HERaPyWItH
P
Roton
P
uMP
I
nHIbItoRs
In
G
ERMany
M.Gross
1
,u.beckenbauer
2
,J.burkowitz
3
,H.Walther
2
,b.brueggenjuergen
3
2
H-M-
1
oIntHeeranlitshtisMcahneagkelimniekntDronMliünlleera,GM,üoncbherehna,cGhienrgm,aGnye,rmany,
3
alphacareGmbH,celle,Germany

Abstract
symptoms,includingasthma,chroniccough,and
Background:
Gastro-oesophagealrefluxdisease(
GERD
)laryngitis[5].Esophagealandextra-esophagealsymp-
isacommondisorderwithconsequencesforthepa-tomsareregardedasthereasonsfortheexperienceof
tient’shealth-relatedqualityoflife(HRQol).InGer-pain,lackofvitality,andfeelingsofpoorphysicaland
many,fewdataareavailableontheimpactofGERDmentalhealth[6].GERDsubstantiallyimpairsallas-
onwork-relatedproductivity.pectsofHRQol[6,7].
Aim:
tostudytheimpactofGERDonworkproduc-thewide-rangingeffectsofGERDonhealthand
tivitydespiteprotonpumpinhibitor(PPI)therapyandwell-beingcanhaveconsequencesfortheperfor-
theassociationbetweenproductivityandsymptomdu-manceoftheaffectedindividuals,particularlyatwork
ration,severity,andHRQol.[8].Inseveralstudiesthathaveanalyzedmeasuresof
Methods:
Retrospectivedatafromrandomlyselectedworkproductivity,thelossofproductivityranged
patientswithchronicGERDsymptoms,treatedbyof-from6%to42%amongindividualswithGERD[8].
fice-basedgeneralpractitionersorgeneralinternistsGERDcausessignificantindirectcostsattributableto
withroutineclinicalcare,wereanalyzedtogetherwithreducedproductivityandtimeoffwork[9].aGer-
informationfromself-administeredinstrumentsas-manstudyshowedthat10%oftotaldisease-related
sessingworkproductivity(WPaI–GERD),symptomscostswereindirectcostsarisingfromworkingdays
(RDQ),andHRQol(QolRaD).losttoillness[2].oneanalysisestimatedalossof
Results:
Reducedproductivitywasreportedby152ofgrossdomesticproductof€688million/yeardueto
249patients(61.0%),although89.5%ofthemwereGERD-relatedinabilitytoworkinGermany[10].
treatedwithPPI.thereductioninworkproductivityInGermany,theimpactofGERDnotonlyonthe
was18.5%inallpatientsand30.3%inthosewithre-abilitytowork[10]butalsoonoverallwork-related
ducedproductivity.Patientswithimpairedproductivityproductivityhasbeenstudiedonlyoncewithinanin-
showedasignificantlylowerHRQolandmore-severeternationalcontext[11].theoveralllossinproductivi-
symptomsofrefluxdisease.Inallpatients,themeantywas3.5hours/week[11].However,theresultswere
sickleaveattributabletorefluxsymptomswas0.6difficulttocomparebecauseanon-standardizedin-
hoursintheprevioussevendaysand1.4workdaysinstrumentwasused.
thepreviousthreemonths.theaimofthisstudywastoexploretheextentof
Conclusion:
GERDhasasubstantialimpactonworkGERD-inducedlossofworkproductivity(working
productivityinGermany,eveninpatientsreceivingdayslostandreducedproductivitywhileworking)ina
routineclinicalcareandPPItherapy.Germanprimary-carepatientpopulationwithchronic
refluxsymptoms.theassociationbetweenproductivi-
Keywords:
Gastro-oesophagealreflux;sickleave;tylossfromGERDsymptomsandhealth-related
Medicaleconomics;ProtonPumpInhibitorsqualityoflife(HRQol)wasalsoanalyzed.
I
ntRoDuctIon
M
atERIalsanD
M
EtHoDs
Gastro-oesophagealrefluxdisease(GERD)isacom-s
tuDy
s
ubJEcts
monandcostlychronicdisorder,withconsequences
forthepatient’shealth-relatedqualityoflife(HRQol)InGermany,theinitialmanagementofGERDoccurs
[1-3].theprevalenceofGERDhasbeenestimatedtoinprimarycare,providedbyoffice-basedphysicians.
bebetween10%and20%intheWesternworld[1].Inthisincludesaclinicalevaluation,furtherdiagnostic
Germany,14%oftheadultpopulationreportmoder-procedures,andmedicaltreatment[12].therefore,pa-
aterefluxsymptomsand4%reportseveresymptomstientswithchronicrefluxsymptomswererandomly
[4].besidesesophagealsymptoms,patientssufferselectedfromasampleofprimary-carepatientsofof-
fromchestpainandavarietyofextra-esophagealfice-basedphysicians(generalpractitioners[GPs]and

.7rGso_smUrbcuvhroaleg710..31011:09Seite125March30,2010EuRoPEanJouRnalofMEDIcalREsEaRcH125
generalinternists)intheMunicharea(bothruralandsia[13].thequestionnaireconsistsof25items,which
urbandistricts)insouthernGermany.allphysiciansareorganizedintofivedomains(3–6itemseach):
cooperatedwiththe“HealthManagementonline”or-emotionaldistress,sleepdisturbance,eatinganddrink-
ganization(H-M-oaG)inoberhaching,southerningproblems,physical/socialfunctioning,andvitality.
Germany,whichselectedtheparticipatingphysicians.thedegreeandfrequencyofdistressandthepatients’
seventeenofthe78physicianswhichwereinvitedtofeelingsduringtheprecedingweekareassessedona
participatetookpartinthestudyincluding13GPsseven-pointlikertscale,withahigherscorerepresent-
and4generalinternists.Dataforthisretrospective,inglessfrequencyordistress.althoughthereisnode-
multicenterobservationalstudywerecollectedbe-tailedevaluationofQolRaD,adifferenceofap-
tweenJulyandnovember,2007.proximatelyonepointisconsideredtobeclinicallyrel-
theinclusioncriteriawere:(1)atleast18yearsold;evant[14].aGermantranslationofQolRaDhas
(2)atleastonevisitbecauseofrefluxsymptomsmoreshowngoodpsychometricqualities[15].
thansixmonthsbeforestudyentryandafollow-up
visitforrefluxsymptomsbetweensixandthree
RefluxDiseaseQuestionnaire(RDQ)
monthsbeforestudyentry.thesecriteriawerechosentheoriginalRDQisadiagnosticinstrumentwith12
toincludeonlypatientswithchronicrefluxdisease.questionsthatevaluatethefrequencyandseverityof
GERDwasdiagnosedbythephysiciansaccordingtoburningbehindthesternum,painbehindthesternun,
theInternationalclassificationofDiseases,tenthRe-upperstomachburning,upperstomachpain,acidtaste
vision(IcD10),GermanModification2007,accord-inthemouth,andmovementofmaterialduringthe
ingtothecodesgivenintable1.anupperendoscopyprecedingfourweeks[16].aGermanversionwascre-
recentlyoralongertimeagowasnotmandatory.theatedtoassessthetreatmentresponseforashorterpe-
exclusioncriteriaincludedothersignificantuppergas-riodofoneweekusingsix-pointscalesrangingfrom
trointestinaldisorders(includingZollinger–Ellisonnooccurrencetodaily/severe[17].thisversionhas
syndrome,gastricorduodenalulcer,esophagealstric-beencarefullyvalidatedandadequatevalidity,reliabili-
ture,andahistoryofdysplasiainbarrett’sesophagus).ty,andsensitivityhavebeendemonstrated.Withprin-
thephysiciansidentifiedallpatientsintheirofficeciplecomponentsanalysis,threefactors(regurgitation,
databasewhofulfilledtheinclusioncriteria.anheartburn,anddyspepsia)wereidentified.acombined
anonymizedlistofpatientswastransferredtothescoreforthefactorsregardingGERDsymptoms(re-
studyorganizationwhichrandomlyselectedthepa-gurgitation+heartburn)couldbecalculated.
tients.thepatientswereinvitedinwritingtopartici-
pateinthestudyandtomakeanappointmentwith
WorkProductivityandActivityImpairment
theirphysician.Writteninformedconsentwasob-
Questionnaire(WPAI–GERD)
tainedfromallpatientsbeforestudyentry.thepa-theWPaI–GERDistheGERD-specificvalidated
tientscompletedthequestionnairesintheofficeofversionofageneralhealthmeasurethathasbeen
theirphysician.modifiedforseveralhealthconditions[18].Itwasde-
velopedtoestimatetheimpactofheartburnandacid
Table1.
IcD10GERDdiagnosticcodesidentifyingPatients
regurgitationonproductivityandhasbecomeastan-
withrefluxdisease.
dardtoolfortheevaluationofworkproductivity[8,
19].thequestionnairecontainsthreeopen-ended
codeDiagnosis
questionsabouthoursabsentfromworkforhealth
reasons,hoursabsentfromworkforotherreasons,
k21Gastroesophagealrefluxdisease
andthenumberofhoursworkedduringthelastseven
days.thepatientswereinstructednottoincludethe
k21.0Gastroesophagealrefluxdiseasewithesophagitis-
timespentparticipatinginthestudyastimeabsent
Refluxesophagitis
fromwork.Intwofurtherquestions,patientsratedthe
k21.9Gastroesophagealrefluxdiseasewithoutesophagitis
impactofrefluxsymptomsontheirproductivity(per-
R12Heartburn-Excludesdyspepsia
centagereductioninproductivityatwork).basedon
theWPaI–GERDresults,aworkproductivityscore
(WPs)wascalculated,whichexpressesthelostpro-
I
nstRuMEnts
ductivitybecauseofGERDsymptomsforeachpa-
tientasapercentageoftheirtotalpotentialproductiv-
Dataconcerningresourceuseandtreatmentwithinity.aWPsofzeromeansnoreducedproductivity,a
theobservationperiodovertheprecedingsixmonthsvalueabovezeromeansreducedproductivity.
wasgatheredretrospectivelyfrompatientrecords.to
measurethetreatmentoutcomesandthepatients’
WPs=[(hoursabsentfromwork+percentagereduced
GERD-relateddistress,aquestionnairewascompleted
productivityatworkhoursactuallyworked)/(hoursab-
bytheparticipants,whichincludedstandardizedvali-
sentfromwork+hourslostforotherreasons+hoursac-
datedself-administeredinstrumentstoassesswork
tuallyworked)]100
productivityandevaluatebothsymptomsandHRQol
inassessingtheresponsetotreatment.
Absenteeismfromworkintheprecedingthreemonths
thepatientswereaskedabouttheirabsenteeism
QualityofLifewithRefluxandDyspepsia(QOLRAD)
fromwork(hoursordays)intheprecedingthree
theQolRaDwasdevelopedtoassessHRQolinmonthsresultingfromrefluxsymptoms,withorwith-
patientssufferingfromGERDsymptomsordyspep-outamedicalcertificate.InGermany,mostemployees

7.Gross_Umbruchvorlage17.03.1011:09Seite126126EuRoPEanJouRnalofMEDIcalREsEaRcHMarch30,2010
mustpresentamedicalcertificatewhenabsentfromwithameanageof48.9years.oftherespondents,
work,althoughsometimesonlywhenabsentformore50%hadhadsymptomsofGERDforatleast3.5
thantwodays.years.Reducedproductivity(WPs>0)wasreported
by152patients(61.0%).Patientswithreducedproduc-
s
tatIstIcal
a
nalysIs
tivityhadsufferedGERDsymptomsforasignificant-
lyshorterperiodthanhadpatientswhoseproductivity
tocomparedifferencesinthecharacteristicsofthewasnotreduced(mean6.1vs9.1years,respectively).
samples,ttestswereusedforcontinuousvariablesandthesexdistribution,full-timeemployment,and
c
2
testsfordiscretevariables.allanalyseswereper-GERDdiagnosis(IcD10codes)weresimilarinthe
formedwithsPss15.0(sPssInc.,chicago,Il,usa).twogroups(table2).therewerenosignificantdiffer-
encesintheuseofeitherprotonpumpinhibitor(PPI)
H
uMan
s
ubJEct
P
RotEctIon
medication(89%)orhistamine-2-receptorantagonists
(13%)betweenpatientswithandthosewithoutre-
thisstudywasconductedinaccordancewiththelat-ducedproductivity.Mostpatientsweretreatedwith
estrevisionoftheDeclarationofHelsinski.thestudyomeprazole(51%ofthepatients),followedbyes-
protocolwasreviewedbytheethicscommitteeoftheomeprazole(16%),pantoprazole(14%),lansoprazole
bavarianstatechamberofPhysicians.(1%),andrabeprazole(1%).
R
Esults
W
oRk
P
RoDuctIvIty
P
atIEnt
c
HaRactERIstIcs
for6%oftherespondents,theirGERDsymptoms
hadbeenacauseofabsenteeismintheprecedingsev-
atotalof627patientswithchronicGERDsymptomsendays.onaverage,thesepatientsmissed10.4work-
wererandomlyselectedfromallthepatientsfulfillinginghoursinthatweek.theaverageabsenceresulting
theinclusioncriteriaaccordingtoprimary-careoffice-fromGERDreportedbyall249patientswas0.63hin
basedGPsandinternists.twohundredsixty-fivethatweek(2.4%ofworktime).
(42.2%)ofthemweregainfullyemployedatthetimetheWPsiscomposedofabsenteeismandreduced
ofthestudy(31.4%full-timeemployment,10.9%productivitywhileworkingattributabletoGERD
part-timeemployment),45.0%wereretired,and7.2%symptoms,andreferstothetotalworkingtime.Inall
wereunemployed.twohundredforty-nine(39.7%)patients,WPswas18.5whichmeansanaveragepro-
weregainfullyemployed,completedtheWPaI–ductivitylossbecauseofGERDsymptomsof18.5%
GERD,andwerethereforeincludedintheanalysis.(table3).Inpatientswithreducedproductivity,WPs
theproportionofmalestofemaleswas109to140,was30.3.

Table2.
studygroupcharacteristics
characteristicpWaotirekinntsg
nt=ota2l49
Meanage[years(±sD)]48.9(11.5)
sex[n(%)]
Male109(43.8)
female140(56.2)
Employment[n(%)]
fulltime166(66,7)
symptomduration
Mean[years(sD)]7.3(8.8)
Median[years(innerquartilerange(]3.5(7.9)
Diagnosis(IcD10)[n(%)]*
k2158(23.3)
k21.0101(40.6)
k21.966(26.5)
R1272(28.9)
Protonpumpinhibitoruse[n(%)]
yes222(89.1)
Histamine-receptor-2useuse[n(%)]
yes33(13.3)
*Multiplediagnosespossible

noreduced
productivity
(nW=P9s)7
49.9(11.7)
46(47.4)
51(52.6)
54(55.7)
9.1(9.7)
5.6(10.1)
20(20.6)
43(44.3)
24(24.7)
29(29.9)
86(88.7)
10(10.3)

Reduced
productivity
(nW=P1s5)2
48.2(11.3)
63(41.4)
89(58.6)
112(73.7)
6.1(7.9)
2.8(6.2)
38(25.0)
58(38.2)
42(27.6)
43(28.3)
136(89.5)
23(15.1)

P
value
5.7003.6.0920.01/na054.0.360.660.890.837.20

.7rGso_sUmbruchvorlage17.03.1011:09Seite127March30,2010EuRoPEanJouRnalofMEDIcalREsEaRcH127
Table3.
Workproductivityscore(WPaI-GERD)forthelastsevendaysinallpatientsandinpatientswithnormalorreduced
productivity[mean(sD)].
componentWorkingnoreducedReduced
P
value
(
timeframe:lastsevendays
)patientsproductivityproductivity
total(WPs)(WPs)
n=249n=97n=152
Hoursabsentfromworkbecauseofrefluxsymptoms0.63(3.75)0.00.65(3.29)n/a
Percentagereducedproductivityatwork17.6(21.3)0.028.9(20.4)n/a
Workproductivityscore(WPs)18.5(22.5)0.030.3(21.8)n/a

Table4.
WorkingdayslostduetoGERDduringtheprecedingthreemonths.
typeofworkingdayslostWorkingnoreducedReduced
P
value
(
timeframe:lastthreemonths
)patientsproductivityproductivity
total(WPs)(WPs)
n=249n=97n=152
totalworkingdayslost1.35(4.83)0.57(2.99)1.84(5.64)0.02
workingdayslostwithmedicalcertificate0.59(2.79)0.47(2.64)0.66(2.88)0.62
workingdayslostwithoutmedicalcertificate0.76(3.67)0.09(0.57)1.18(4.61)<0.01

beyondtheWPaI–GERD,weaskedthepatientsHRQ
o
l
howmanyworkingdayshadbeenlostduringthepre-
cedingthreemonths.InGermany,manyemployeesReducedHRQolcorrelatedsignificantlywithim-
onlyrequireamedicalcertificatefromaphysiciancon-pairedproductivity(table5).Patientswithreduced
firmingtheirillnessforanabsenceofmorethantwoproductivityshowedasignificantlylowerHRQol
days.Intotal,1.35±4.83workingdayswerelostininalldimensionsofQolRaD.thelargestmean
thelastthreemonths(table4).themeannumberofdifferenceswereobservedinthedimensions“emo-
lostworkingdaysamongthe12.1%ofall249patientstionaldistress”(0.84points)and“vitality”(0.83
withabsencefromworkwas11.1±8.89days.thepoints).thelowesttotalscoreswerereportedbypa-
overallmeannumberofworkingdayslostwithamed-tientswithreducedproductivityinthedimensions“vi-
icalcertificateforGERDwas0.59±2.78days.thistality”,“sleepdisturbance”,and“food/drinkprob-
kindoflostworkingdayswasreportedby7.1%ofpa-lems”.
tients(mean8.4±6.59days).Patientsalsoreportedans
yMPtoM
s
EvERIty
averageof0.76±3.67lostworkingdayswithouta
medicalcertificate(7.5%ofpatientswithameanlosssymptomassessmentrevealedahigherfrequencyof
of9.63±9.36days).GERDandworsesymptomsduringthepreceding
Patientswithreducedproductivityduringthepre-sevendaysinpatientswithreducedworkproductivity
cedingsevendaysshowedsignificantlymorelostwork(table6).significantdifferenceswereobservedon
daysintheprecedingthreemonths(table4).onlytheeachRDQsymptomscaleforthesepatients.Regurgi-
daysoffwithoutamedicalcertificate(usuallylessthantationwasthemostrelevantsign,withthehighest
threedaysabsence)differedsignificantlybetweenthemeanscore(1.84)andthegreatestdifferencebetween
twogroups,notthedayslostduringalongerperiodofemployeeswithoutreducedproductivityandthose
inabilitytowork.withreducedproductivity(–0.44).

Table5.
Health-relatedQualityoflife(QolRaD)inallpatientsandinpatientswithnormalorreducedproductivity.
QolRaDdimensionWpaotriekinntsgpnroodreudctuicvietdyprRoedduucctievdityDifference
P
value
nt=ota2l49(nW=P9s)7(nW=1P5s)2
Emotionaldistress5.34(1.47)5.85(1.39)5.01(1.44)0.84<0.001
food/drinkproblems5.17(1.32)5.52(1.37)4.95(1.24)0.58<0.01
Physical/socialfunctioning5.87(106)6.29(0.99)5.60(1.01)0.68<0.001
sleepdisturbance525(1.48)5.72(1.46)4.95(1.41)0.77<0.001
vitality5.17(1.47)5.67(1.45)4.84(1.38)0.83<0.001

7.Gross_Umbruchvorlage17.03.1011:09Seite128128EuRoPEanJouRnalofMEDIcalREsEaRcHMarch30,2010
Table6.
symptomscore(RefluxDiseaseQuestionnaireRDQ)inallpatientsandinpatientswithnormalorreducedproductivity.
RDQscaleWorkingnoreducedReducedDifference
P
value
patientsproductivityproductivity
nto=ta2l49(nW=Ps9)7n(W=P1s5)2
Regurgitation1.67(1.41)1.40(1.39)1.84(1.40)–0.440.02
Heartburn1.23(1.36)1.00(1.29)1.38(1.39)–0.380.04
Dyspepsia1.48(1.36)1.21(1.35)1.64(1.33)–0.430.01
GERD
(regurgitation+heartburn)1.45(1.22)1.20(1.20)1.61(1.20)–0.41<0.01

D
IscussIon
thisstudyevaluatedagroupofemployedpatientsvis-
itingaGPorprimary-careinternistforchronic
GERDsymptoms.theanalysiswasbasedonretro-
spectivedataandself-administeredinstrumentswere
usedtodeterminetheextentofGERD-causedlossof
workproductivityanditsassociationwithGERD
symptomsandHRQol.tothebestofourknowl-
edge,thisisthefirstGermanstudytousethestan-
dardizeddisease-specificWPaI–GERDquestionnaire
toquantifyproductivitylossandcomparetheresults
withinternationalstudies.
ofthepatientsevaluated,12.1%hadreportedab-
sencefromworkattributabletoGERDsymptomsin
theprecedingthreemonths.thiscorrespondsvery
welltothe14%ofemployedpatientsreportingdays
ofsickleaveintheprecedingyearintheGerman
ProGERDstudy[10].sixty-onepercentoftheem-
ployedpatientsreportedreducedproductivityattribut-
abletoGERDwhileatworkintheprecedingseven
days,resultinginameanabsencefromworkof0.63
hoursandareductionof18.5%inoverallworkpro-
ductivity(WPs0,185).thisabsencefromworkand
WPsarelowerthanthosereportedinotherstudies.
amongtheswedishworkingpopulationconsultinga
GPforcurrentorrecentsymptomsofheartburn,a
meanabsencefromworkof2.5hperweekwasre-
ported,withaWPsof23%[20].Inastudyinspain
amongpatientswithnocturnalheartburn,ameanab-
sencefromworkof1.4handaWPsof26%werere-
ported[21].thesedifferencesinsickleavemayindi-
catethatsocioethicalorsocioeconomicfactorsinflu-
encepatients’willingnesstobeabsentfromworkbe-
causeofrefluxsymptoms.
Whenthelostworkingdaysareextrapolatedtothe
totalnumberofworkingdays(1.35of65working
daysinthreemonths),anaverageof2.1%inthree
monthswascalculated,onlyslightlylowerthanthe
2.4%oflostworktimemeasuredwiththe
WPaI–GERDintheprecedingsevendays.onlyone
studyinspainusedasimilarapproachandreported
absenteeismofthesamemagnitude[22].theGerman
ProGERDstudyreportedthat2.5workingdayshad
beenlostbecauseofGERDintheyearbeforethepa-
tients’inclusioninthestudy[10].thisdifferenceof
2.5days/yearversus1.35days/threemonthsmaybe
theresultofrecallbias.Whenpatientsreporttheir
daysoffworkfortheprecedingyear,thedataproba-
blyunderestimatethedisease-relatedabsencesfrom

work.Ithasbeenshownthatthereisarelevantrecall
biasevenwhenself-reportedabsencesfromworkina
four-weekrecallperiodarecomparedwiththosefora
twooroneweekperiod[23].therefore,ourfindingof
1.35lostworkingdaysinthreemonthsmaybeanac-
curateestimateofthedayslosttoworkinGermany.
Respondentswithreducedproductivity(WPs>0)
hadsignificantlymoredaysoffwithoutamedicalcer-
tificate(indicatingshortperiodsofabsenteeism,for
1–2days),whereaslongerperiodsofinabilitytowork
(withamedicalcertificate)didnotdiffersignificantly
betweenthetwogroups.
clearandconsistentassociationswerefoundbe-
tweenHRQolandreducedproductivityatworkinall
dimensionsoftheQolRaD.theseresultsconfirm
thoseofanotherGermanstudy.themeanscoresin
thegroupofpatientswithreducedproductivitywere
similartoorworsethanthoseofpatientswithmoder-
ateheartburnintheGermanQolRaDvalidation
study[15].thereweremajordifferencesinHRQol
betweenpatientswithandwithoutreducedproductivi-
tyinthedimensions“vitality”and“emotionaldistress”.
thismaypointtosomepsychologicalstraincausedby
acuteGERDsymptoms.“sleepdisturbance”and
“food/drinkproblems”werealsosignificantlylowerin
patientswithreducedproductivity,correspondingwell
tothefindingthatnocturnalsymptomsareasignifi-
cantpredictorofreducedworkproductivity[24].
symptomseverity(RDQ)correlatesbothwith
HRQolandworkproductivity.Patientswithhigher(
i.e.,worse)resultsontheRDQhadsignificantmore
reducedproductivityatworkandimpairedHRQol.
theRDQscale“regurgitation”turnedouttobethe
mostrelevantscalewiththelargestdifferenceand
highestmeanscore.
Mostofthepatientsinthisstudy(61%)experi-
encedaninabilitytoworkoralossofproductivity,al-
though89%ofallpatientsweretreatedwithPPIs.
thisproportionwashigherthanthetreatedpatientsin
otherstudies,inwhichonly13%–30%ofpatients
tookPPImedications[22,24,25].theuseofPPIin
thisstudyissimilaronlytothefrequencyofPPI-treat-
edpatients(78.4%)inarecentaustralianinvestigation
[26].thishighpercentageofpatientstreatedwithPPI
ismostlikelyduetotheinclusioncriteria(patients
treatedwithroutineclinicalcare).obviously,thehigh
rateofpatientstreatedwithPPImedicationdidnot
effectivelypreventabsencesfromwork.
thelackofdifferenceinPPIusebetweenthepa-
tientswithandwithoutreducedproductivityshould

7.Gross_Umbruchvorlage17.03.1011:09Seite129March30,2010EuRoPEanJouRnalofMEDIcalREsEaRcH129
beevaluatedinmoredetail.severalexplanationsaretoagreaterimpactonworkproductivitybecauseof
possible.Inthisretrospectivestudy,patientswithmore-severesymptoms.
more-severesymptomsmayhavebeentreatedwithathevastmajorityofpatientsweretreatedwith
higherdoseoramorepotentPPIthanpatientswhoomeprazole.forthisreason,nocomparisonoftheef-
werelessaffected.furthermore,mostpatientsmayficacyofvariousPPIsonworkproductivitycouldbe
havebeenonademandtherapyregimen.thenumbermade.Moreover,insufficientdatawereobtainedre-
ofdaysonwhichtheyreceivedPPImedicationmaygardingtheprescribedtherapyregimens(ondemand
havedifferedinthetwopatientgroups.However,theordailyuseofPPIs).therecallperiodofsixmonths
samplesizeinthisstudywastoosmalltoaddressfortheprescribedmedicationwastooshortandthe
thesequestions.meannumberofconsultationswiththepatientswas
thelossofgrossdomesticproductcanbeestimat-toolowtocalculatetheaveragenumberoftabletstak-
edbasedonthereporteddayslosttowork.thehu-enperday.therefore,thesetwotherapeuticregimens
mancapitalmethodusesthefullreplacementcosts,in-couldnotbecomparedinthisstudy.
dependentofwhethertheworkerisreplacedornot
[27].basedonthehumancapitalmethodofcalculat-
c
onclusIons
ingthecostsofillness,thetotallossofgrossdomestic
productisintheorderof4.2billioneurosannuallyinGERDhasasubstantialeffectonemployees’produc-
Germany(1.35lostworkingdaysinthreemonthstivityinGermany.obviously,anappreciableproduc-
equals5.4lostworkingdaysperyear,33millionem-tivitylossexists,evenamongpatientsinroutineclini-
ployees,0.14prevalenceofmoderaterefluxsymptomscalcareandundergoingtreatmentwithPPI.symptom
[4],€170/daymeandailygrosswage).However,thisisseverityandimpairedHRQolaresignificantpredic-
probablyanover-estimate.Inthepresentstudy,onlytorsofreducedworkproductivity.furtherinvestiga-
patientswithchronicrefluxsymptomswhohadpre-tionsoflargerstudypopulationsandtheinclusionof
sentedtwicetoaphysicianwereincluded(atleastonepatientsunderspecialistcarewouldbebeneficialinex-
visitatleastsixmonthsbeforeenrolmentandasecondaminingthereasonsforthesuboptimalresponseto
visit3–6monthsbeforeenrolment).thisprobablyPPItherapyintermsofproductivityloss.
representsagroupofpatientwithsevereorrefractory
GERD,resultinginahighernumberofsickleavedays
Disclosure:
thestudywassupportedbyanunrestrictedre-
thaninthewholegroupofGERDpatients.theremay
searchgrantfromastraZenecaGmbH,Wedel,Germany.
alsobeaselectionbiastowardspatientswithincreased
numbersofsickleavedaysintheprecedingsix
months,attributabletotheinclusioncriteria.However,
R
EfEREncEs
ifthesickleavedayswererepresentativeofonlyone
1.DentJ,El-seragHb,WallanderMa,Johanssons.Epi-
fifthofthe14%ofthepopulationwithmoderatere-
demiologyofgastro-oesophagealrefluxdisease:asystem-
fluxsymptoms,thelossofgrossdomesticproduct
aticreview.Gut2005May;54(5):710–7.
wouldstillbeintheorderof800millioneurosannual-
2.Willichsn,noconM,kuligM,JaspersenD,labenzJ,
ly.thisestimateisclosetothe€668million/yearcal-
Meyer-sabellekW,stolteM,lindt,MalfertheinerP.
culatedintheGermanProGERDstudy[10].
cost-of-diseaseanalysisinpatientswithgastro-oe-
sophagealrefluxdiseaseandbarrett’smucosa.aliment
Pharmacolther2006feb1;23(3):371-6.
s
tREnGtHsanD
l
IMItatIonsoftHE
s
tuDy
3.kuligM,leodoltera,viethM,schulteE,JaspersenD,
labenzJ,lindt,Meyer-sabellekW,MalfertheinerP,
themajorstrengthofourstudyisthattheanalysisof
stolteM,Willichsn.Qualityoflifeinrelationtosymp-
productivitylosswasmadewiththemostwidelyused
tomsinpatientswithgastro-oesophagealrefluxdisease—
GERD
-specificvalidatedquestionnaire(
WPaI–GERD
).
ananalysisbasedontheProGERDinitiative.aliment
tothebestofourknowledge,thiskindofstudyhas
Pharmacolther2003;oct15;18(8):767-76.
notbeenperformedbeforeinGermany.thus,theim-
4.noconM,keilt,Willichsn.Prevalenceandsociode-
pactofrefluxdiseaseonworkproductivityinaran-
mographicsofrefluxsymptomsinGermany—results
domsampleofGERDpatientswasdemonstratedand
fromanationalsurvey.alimentPharmacolther2006
Jun1;23(11):1601–5.
comparedwithinternationalresults.
5.HunginaP,Raghunathas,WiklundI.beyondheart-
thestudyhasseverallimitations.first,thestudyis
burn:asystematicreviewoftheextra-oesophagealspec-
anobservationaldesign,whichdoesnotallowforthe
trumofreflux-induceddisease.famPract.2005Dec;
directcomparisonofdifferenttreatmentregimensor
22(6):591-603.
forrisk-factorassessment.second,insufficientdata
6.WiklundI.Reviewofthequalityoflifeandburdenofill-
wereavailableonco-morbidities.thereforewecould
nessingastroesophagealrefluxdisease.DigDis2004;
notperformalogisticregressionmodeltoanalyze
22(2):108–14.
whetherGERDisanindependentpredictorofthe
7.RonkainenJ,aroP,storskrubbt,lindt,bolling-
lossofproductivity.However,itcanbestatedthata
sternevaldE,Junghardo,talleynJ,agreusl.Gastro-
highpercentageofGermanpatientswithchronicre-
oesophagealrefluxsymptomsandhealth-relatedquality
oflifeintheadultgeneralpopulation-thekalixanda
fluxdiseasereportareducedworkproductivity.
study.alimentPharmacolther2006Jun15;23(12):1725-
furthermore,therespondentswererecruitedby
33.
primary-carephysicians.Itcanbeassumedthatin
8.WahlqvistP,ReillyMc,barkuna.systematicreview:the
Germany,themore-severecasesaretreatedbyoffice-
impactofgastro-oesophagealrefluxdiseaseonworkpro-
basedspecialists.theconsequencesareunclearand
ductivity.alimentPharmacolther2006Jul15;24(2):
rangefrombettertreatmentwithlessproductivityloss
259-72.

.7rGoss_Umbruchvorlage17.03.1011:09Seite130130EuRoPEanJouRnalofMEDIcalREsEaRcHMarch30,2010
9.WahlqvistP,brookRa,campbellsM,WallanderMa,19.WahlqvistP,carlssonJ,stalhammarno,WiklundI.va-
alexanderaM,smeedingJE,kleinmannl.objectivelidityofaWorkProductivityandactivityImpairment
measurementofworkabsenceandon-the-jobproductivi-questionnaireforpatientswithsymptomsofgastro-
ty:acase–controlstudyofusemployeeswithandwith-esophagealrefluxdisease(WPaI-GERD)—resultsfroma
outgastroesophagealrefluxdisease.JoccupEnvironcross-sectionalstudy.valueHealth2002Mar-apr;
Med2008Jan;50(1):25-31.5(2):106-13.
10.leodoltera,noconM,kuligM,Willichsn,Malfer-20.WahlqvistP.symptomsofgastroesophagealrefluxdis-
theinerP,labenzJ.Gastroesophagealrefluxdiseaseisease,perceivedproductivity,andhealth-relatedqualityof
associatedwithabsencefromwork:Resultsfromalife.amJGastroenterol2001aug;96(8suppl):s57-61.
prospectivecohortstudy.WorldJGastroenterol200521.callejaJl,bixquertM,MaldonadoJ.Impactofnocturnal
Dec7;11(45):7148-51.heartburnonqualityoflife,sleep,andproductivity:the
11.likerH,JonesR,DucrotteP.theeffectofsleepdistur-sInERGEstudy.DigDissci2007oct;52(10):2858-65.
banceduetogastroesophagealrefluxdieseaseonwork22.ReyE,Elola-olasoc,Rodríguezartalejof,Díaz-Rubio
andleisureproductivity:resultsfromamultinationalsur-M.Impactofgastroesophagealrefluxsymptomson
vey.Gastroenterology2005;128:a386healthresourceusageandworkabsenteeisminspain.Rev
12.Meininga,Driesnacku,classenM,Röscht.Manage-EspEnfermDig2006Jul;98(7):518–26.
mentofgastroesophagealrefluxdiseaseinprimarycare:23.stewartWf,RicciJa,leottac.Health-relatedlostpro-
resultsofasurveyin2areasinGermany.ZGastroen-ductivetime(lPt):recallintervalandbiasinlPtesti-
terol2002Jan;40(1):15–20.mates.JoccupEnvironMed2004Jun;46(6suppl):s12-
13.WiklundIk,Junghardo,GraceE,talleynJ,kammM,22.
veldhuyzenvanZantens,ParéP,chiban,leddinDs,24.Deanbb,crawleyJa,schmittcM,WongJ,ofmanJJ.
bigardMa,colinR,schoenfeldP.QualityoflifeinRe-theburdenofillnessofgastro-oesophagealrefluxdis-
fluxandDyspepsiapatients.Psychometricdocumenta-ease:impactonworkproductivity.alimentPharmacol
tionofanewdisease-specificquestionnaire(QolRaD).ther2003May15;17(10):1309–17.
EurJsurgsuppl1998;583:41–9.25.JonesR,armstrogD,MnalfertheinerP,DucrottéP.
14.crawleyJ,frankl,Joshua-Gotlibs,flynnJ,franks,Doesthetreatmentofgastroesophagealrefluxdisease
WiklundI.Measuringchangeinqualityoflifeinresponse(GERD)meetpatients’needs?asurvey-basedstudy.
toHelicobacterpylorieradicationinpepticulcerdisease:currMedResopin2006april;22(4):657–62.
theQolRaD.DigDissci2001Mar;46(3):571-80.26.kirbycn,Pitermanl,nelsonMR,DentJ.Gastro-oe-
15.kulichkR,MalfertheinerP,Madischa,labenzJ,bay-sophagealrefluxdisease--impactofguidelinesonGP
erdörfferE,Miehlkes,carlssonJ,WiklundIk.Psycho-management.austfamPhysician2008Jan-feb;37(1-2):
metricvalidationoftheGermantranslationoftheGas-73–7.
trointestinalsymptomRatingscale(GsRs)andQuality27.koopmanschapMa,Ruttenff.apracticalguideforcal-
oflifeinRefluxandDyspepsia(QolRaD)question-culatingindirectcostsofdisease.Pharmacoeconomics
naireinpatientswithrefluxdisease.HealthQuallife1996nov;10(5):460-6.
outcomes2003oct28;1:62.
16.shawMJ,talleynJ,beebetJ,Rockwoodt,carlssonR,
Received:August20,2009/Accepted:September8,2009
adliss,fendrickaM,JonesR,DentJ,bytzerP.Initial
validationofadiagnosticquestionnaireforgastroe-
sophagealrefluxdisease.amJGastroenterol2001Jan;
96(1):52-7.
17.noconM,kuligM,leodoltera,MalfertheinerP,Willich
sn.validationoftheRefluxDiseaseQuestionnairefora
Germanpopulation.EurJGastroenterolHepatol2005
feb;17(2):229–33.
18.ReillyMc,Zbrozekas,DukesEM.thevalidityandre-
producibilityofaworkproductivityandactivityimpair-
mentinstrument.Pharmacoeconomics1993nov;4(5):
353-65.

Addressforcorrespondence:
Prof.Dr.ManfredGross
InternistischeklinikDr.Müller
amIsarkanal36
81379München
E-mail:gross@muellerklinik.de