David A. Johnson, MD, reported at the recent 2010 American College of Gastroenterology meeting his study of GERD patients and their performance on the simulated driving test. Johnson and colleagues hypothesized that treatment with a PPI would improve nocturnal GERD symptoms, associated sleep disturbance, and performance on a simulated driving test. Each test was performed by use of a validated commercial driving simulator that generates realistic roadway images in response to driver input (steering, throttle, brake, etc.). The test's primary metric was standard deviation of lane variation, assessed every 0.5 second during each test period.
Utilizing this driving simulator, the study showed that performance deteriorated significantly over two weeks in GERD patients without proton pump inhibitor (PPI) therapy; the therapy reversed the trend and led to significant improvement on the test.
The 11 patients treated with the PPI esomeprazole (Nexium) had an 85% decrease in the frequency of disordered sleep, which was associated with an identical improvement in symptom scores for gastroesophageal reflux disease (GERD).
Each patient completed six consecutive 10-minute driving tests after a 14-day period off PPI therapy and after four weeks of treatment with the PPI. The study involved otherwise healthy adults with longstanding GERD. Nine of the patients were women; the average age was 49. During the 14 days off treatment, the proportion of nights with disordered sleep averaged 62.5% and decreased to an average of 9.5% during esomeprazole therapy (P<0.001). The GERD symptom score averaged 2.10 off PPI therapy and 0.33 on therapy (P<0.001). The measure of lane variation increased significantly over time when the patients were off PPI therapy (P=0.002) and then decreased significantly during treatment with esomeprazole (P=0.004).
This study highlights the far reaching effects of GERD that impact on quality of life and work performance. GERD is not just about heartburn!