Systematic review: the burden of disruptive gastro-oesophageal reflux disease on health-related quality of life.

Summary Background About one-third of patients with gastro-oesophageal reflux disease (GERD) have frequent and/or severe reflux symptoms (‘disruptive GERD’). The relative burden of disruptive GERD on health-related quality of life (HRQL) has not been systematically investigated. Aim To assess the burden of disruptive vs. nondisruptive GERD on HRQL. Methods Systematic searches were conducted in PubMed and Embase. To be included, studies had to have used validated questionnaires to assess HRQL. Results Nineteen studies were included. Data on the comparative burden of frequent (ranging from daily to ≥weekly) and severe reflux symptoms were provided in eight and 13 studies respectively; six reported on the additional burden of nocturnal symptoms. Compared with individuals with nondisruptive GERD, those with disruptive GERD had 2.4-times and 1.5-times higher mean rates of absenteeism and presenteeism respectively (five studies), 1.5-times lower sleep quality scores (three studies), 1.1-times lower mean summary scores for physical and mental health (five studies) and 1.3-times lower mean scores for psychological and general well-being (four studies). Increasing symptom frequency and severity both increased the burden of disease to a similar extent. The presence of nocturnal symptoms in addition to daytime symptoms led to worsening of physical health, but their effect on mental health and work productivity was less clear. Conclusions Disruptive GERD is associated with a high burden of disease compared with occasional or mild reflux symptoms. Disease management needs to vary across the GERD spectrum and should be tailored to patients' requirements for optimal therapeutic outcomes.