Studies in the United States have revealed that
gastroesophageal reflux disease (
GERD) patients often suffer from nocturnal symptoms, sleep disturbance, and impaired quality of life. In a large subset of patients, these symptoms persist in spite of
acid suppressive
therapy. The aim of the present study was to assess the prevalence of
heartburn and associated sleep complaints and the response to standard medical
therapy with
pantoprazole in primary and secondary care
esophagitis patients in Belgium. Questionnaires were provided to consecutive patients presenting to primary and secondary care physicians with
esophagitis. The questionnaire evaluated the presence of typical reflux symptoms, alarm symptoms, risk factors, and sleep quality impairment as a result of reflux episodes. Results are shown as mean ± standard deviation and compared by Student's t-test or chi-square test. A total of 4061 primary and 5261 secondary care patients (50% female, mean age 53 ± 0.2 years, body mass index of 25.7 ± 0.1 kg/m(2) ) were recruited. Eighty-four percent of patients reported sleep disturbance attributable to nighttime reflux, including typical nighttime supine reflux symptoms (72%), difficulties to fall asleep (39%), waking up during the night (45%), morning
fatigue (35%), and reflux symptoms when waking up in the morning (47%). Mild, moderate, or severe nighttime
heartburn were reported by, respectively, 30, 35, and 12%, and these numbers were 26, 28, and 6% for nighttime regurgitation. Alcohol (19%), smoking (22%), higher
esophagitis grades (grades 2, 3, and 4 in, respectively, 31, 7, and, 7%), alarm symptoms (27%), and more severe
heartburn and regurgitation during daytime were all significantly associated with all dimensions of sleep disturbance (P < 0.0001).
Obesity was only related to symptoms in supine position and when waking up (P < 0.0001). After 1.4 ± 0.0 months of treatment with
pantoprazole, any sleep disturbance had improved in more than 75% of patients, with resolution of nighttime
heartburn and regurgitation in, respectively, 75 and 83%. The majority of patients presenting with reflux symptoms and
esophagitis in primary or secondary care experience nighttime
heartburn and regurgitation, and sleep disturbance by nighttime symptoms is present in 84%. Smoking, alcohol use, higher grades of
esophagitis, more severe typical reflux symptoms during daytime, and the presence of alarm symptoms are risk factors for
GERD-related sleep disturbance. On standard
therapy with
pantoprazole, nighttime symptoms improved in more than 75%. These observations support a direct relationship between
GERD and sleep disturbance.