Poster Presentation 
Pathogenesis of Reflux Disease 
Monday, September 27, 2004, 12.15-14.00

Abstract: MON-G-138

Citation: Gut 2004; 53 (Suppl VI) A99

IMPACT OF NOCTURNAL HEARTBURN ON QUALITY OF LIFE, SLEEP AND PRODUCTIVITY: THE SINERGE STUDY

M. Bixquert1, J. Calleja2, J. Maldonado3, E. Ballesteros4, S. Vara5, F. Rico-Villademoros6

1 Servicio de Digestivo, Hospital Arnau de Vilanova, Valencia, 2 Servicio de Digestivo, Clínica Puerta de Hierro, Madrid, 3 Servicio de Digestivo, Hospital Carlos Haya, Málaga, 4 Gestión y Desarrollo, 5 Estadística, 6 Dirección Médica, Biométrica, Madrid, Spain

INTRODUCTION: Nocturnal heartburn (NHB) occurs in a large majority of HB sufferers and seems to produce a greater impairment than non-nocturnal heartburn (NNHB).
AIMS & METHODS: The aim of the SINERGE study was to assess the impact of NHB on quality of life, sleep and productivity. In addition, we aimed to estimate the prevalence of consultation for HB. Ambulatory patients who were over 18 years old, were classified as defined cases of HB, uncontrolled hypertension (HTS) and symptomatic depression (DPS), and who gave their informed consent were included in this cross-sectional study. Information on age, sex, BMI and comorbidity was collected and the following validated questionnaires were applied: SF-12, PSQI and WPAI.
RESULTS: 108 primary care Spanish physicians recruited 778 consecutive evaluable patients who were defined cases of NHB (n=337), NNHB (n=139), HTS (n=198) or DPS (n=104). The prevalence of primary care consultation for HB and NHB was 4.7% (2,764/58,735 consultations; 95%CI, 4.5-4.9) and 1.9% (1,129/58,735 consultations; 95%CI, 1.8-2.0) respectively and was similar to that found of consultations for depression (4.2%; 95%CI, 4.0-4.4). Results of analysis of covariance, adjusting for age, sex and comorbidity, for comparing physical and mental components of the SF-12, PSQI total score and the WPAI scores are presented in the table below. 

TABLE 1: Impact of nocturnal heartburn 

	       NHB       	  NNHB  	    HTS    	    DPS     

SF-12 Physical Component	 39.8(0.5)a,b  	42.9(0.8)	43.0(0.7)	39.1(1.0) 
SF-12 Mental Component	   49.5(0.5)c    	51.5(0.8)	51.2(0.7)	32.2(1.0) 
PSQI total score	 8.2(0.2)a,b,c  	 6.7(0.3) 	 6.7(0.3) 	12.5(0.4) 
Reduced productivity work (WPAI)	 26.6(2.1)b,c  	24.9(2.9)	12.6(3.6)	58.6(4.2) 
Reduced productivity activities (WPAI)	40.2(1.3)a,b,c 	29.6(2.1)	22.1(1.8)	67.0(2.5) 

a,b,c: p<0.05 as compared with NNHB, HTA and DPS respectively. 
 	
CONCLUSION: 1. HB and NHB seem to be common causes of consultation in the primary care setting in Spain. 2. Health-related quality of life (especially the physical component), sleep and productivity are significantly impaired in patients with frequent NHB symptoms as compared with those of the patients without nocturnal symptoms or HTS.