Can J Gastroenterol Vol 16 No 7 July 2002 439 ORIGINAL ARTICLE Early relief of upper gastrointestinal dyspeptic symptoms: A survey of empirical therapy with pantoprazole in Canadian clinical practice David Armstrong MA FRCPUK FRCPC 1 , Farouk Kazim MSc MA 2 , Marcel Gervais BSc 3 , Myron Pyzyk BSc MS 4 1 Division of Gastroenterology, McMaster University, Hamilton, Ontario; 2 Clinical R & D Network, Oakville, Ontario; 3 Clinical Monitoring Group, Moncton, New Brunswick; 4 Solvay Pharma Inc, Scarborough, Ontario Correspondence: Dr D Armstrong, Division of Gastroenterology, HSC-4W8, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5. Telephone 905-521-2100 ext 76404, fax 905-521-4958, e-mail armstro@mcmaster.ca Received for publication August 7, 2001. Accepted April 22, 2002 D Armstrong, F Kazim, M Gervais, M Pyzyk. Early relief of upper gastrointestinal dyspeptic symptoms: A survey of empirical therapy with pantoprazole in Canadian clinical practice. Can J Gastroenterol 2002;16(7):439-450. BACKGROUND: Upper gastrointestinal symptoms attributa- ble to gastroesophageal reflux disease or peptic ulcer are common, but the outcome of proton pump inhibitor therapy in clinical practice is not well documented. AIM: To assess the range of upper gastrointestinal acid-related symptoms in clinical practice and the rapidity of their response to pantoprazole (40 mg daily), after seven days of therapy. METHODS: A total of 726 Canadian physicians (65.3% family physicians) recorded a working diagnosis and alarm features in eligible patients, who then recorded the severity of eight upper gastrointestinal symptoms in a daily symptom diary during the first week of therapy. RESULTS: Complete data were obtained from 2273 (37.3% male) of 3261 patients; physicians diagnosed reflux esophagitis alone (66.9%), peptic ulcer (9.7%), other upper gastrointestinal disorders (12.3%) and reflux esophagitis with another diagnosis (11.1%). Alarm features were common (29.6%), but a history of gastrointestinal blood loss was rare (less than 1%). Mean daytime heartburn scores decreased from 2.59 to 1.40, and epigastric pain scores decreased from 2.54 to 1.56 over the first week (P<0.00001); the proportions of patients who became symptom- free were 68.1% and 55.4%, respectively. Decreased mean symp- tom scores were also observed for acid regurgitation (2.21 to 1.35), bloating (2.47 to 1.57), nausea (2.03 to 1.36), slow digestion (2.51 to 1.56) and burping (2.56 to 1.69). The percentage of patients with severe or very severe symptoms decreased from 53.5% to 13.8% at day 7. The physician’s initial diagnosis was not predictive of outcome. CONCLUSIONS: In a predominantly primary care population with upper gastrointestinal acid-related symptoms, proton pump inhibitor therapy produces prompt symptomatic relief in most patients. Potential alarm symptoms are common, and further research is required to determine the absolute risk of alarm symp- toms and their implications for empirical therapy. Key Words: Acid-related symptoms; Dyspepsia; Gastroesophageal reflux disease; Pantoprazole; Proton pump inhibitor; Upper gastrointestinal dyspeptic symptoms Résumé à la page suivante