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Gastroesophageal reflux disease in primary care: using changes in proton pump inhibitor therapy as an indicator of partial response.
Scand J Gastroenterol. 2012 Jul; 47(7):751-61.SJ

Abstract

OBJECTIVE

Up to one-third of patients with gastroesophageal reflux disease (GERD) in primary care have residual symptoms despite proton pump inhibitor (PPI) therapy. We aimed to characterize partial response to PPIs among adult patients in UK primary care.

MATERIAL AND METHODS

Newly diagnosed GERD patients aged 20-79 years who were prescribed PPI for treatment of GERD were identified in The Health Improvement Network. Those with a treatment change suggesting partial response to PPIs (new treatment added to PPI, increased PPI dose, or switching PPI) during the subsequent 6 months were identified as potential cases and confirmed after manual review of each patient's complete computer medical record including free-text comments. Patients without these treatment changes were study controls. A nested case-control analysis was conducted using logistic regression.

RESULTS

The proportion of newly diagnosed GERD patients with partial response to PPI therapy was 18.6% (1201/6453). Partial response was associated with female gender (odds ratio [OR]: 1.20; 95% confidence interval [CI]: 1.05-1.37), anxiety or depression (OR: 1.15; 95% CI: 1.00-1.31), and prescription of ≥ 6 drugs in the month before GERD diagnosis (OR: 1.42; 95% CI: 1.14-1.78). Among new PPI users (n = 2907), partial response was associated with esophageal ulcer or Barrett's esophagus at initial diagnosis (OR: 3.14; 95% CI: 1.60-6.17).

CONCLUSIONS

Approximately one in five newly diagnosed patients with GERD appear to have a partial response to PPI therapy. Female gender, polymedication, and a severe initial diagnosis may be associated with partial response.

Authors+Show Affiliations

Spanish Centre for Pharmacoepidemiologic Research-CEIFE, Madrid, Spain. aruigomez@ceife.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22519917

Citation

Ruigómez, Ana, et al. "Gastroesophageal Reflux Disease in Primary Care: Using Changes in Proton Pump Inhibitor Therapy as an Indicator of Partial Response." Scandinavian Journal of Gastroenterology, vol. 47, no. 7, 2012, pp. 751-61.
Ruigómez A, Johansson S, Wernersson B, et al. Gastroesophageal reflux disease in primary care: using changes in proton pump inhibitor therapy as an indicator of partial response. Scand J Gastroenterol. 2012;47(7):751-61.
Ruigómez, A., Johansson, S., Wernersson, B., Fernández Cantero, O., & García Rodríguez, L. A. (2012). Gastroesophageal reflux disease in primary care: using changes in proton pump inhibitor therapy as an indicator of partial response. Scandinavian Journal of Gastroenterology, 47(7), 751-61. https://doi.org/10.3109/00365521.2012.679682
Ruigómez A, et al. Gastroesophageal Reflux Disease in Primary Care: Using Changes in Proton Pump Inhibitor Therapy as an Indicator of Partial Response. Scand J Gastroenterol. 2012;47(7):751-61. PubMed PMID: 22519917.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastroesophageal reflux disease in primary care: using changes in proton pump inhibitor therapy as an indicator of partial response. AU - Ruigómez,Ana, AU - Johansson,Saga, AU - Wernersson,Börje, AU - Fernández Cantero,Oscar, AU - García Rodríguez,Luis A, Y1 - 2012/04/23/ PY - 2012/4/24/entrez PY - 2012/4/24/pubmed PY - 2012/11/1/medline SP - 751 EP - 61 JF - Scandinavian journal of gastroenterology JO - Scand. J. Gastroenterol. VL - 47 IS - 7 N2 - OBJECTIVE: Up to one-third of patients with gastroesophageal reflux disease (GERD) in primary care have residual symptoms despite proton pump inhibitor (PPI) therapy. We aimed to characterize partial response to PPIs among adult patients in UK primary care. MATERIAL AND METHODS: Newly diagnosed GERD patients aged 20-79 years who were prescribed PPI for treatment of GERD were identified in The Health Improvement Network. Those with a treatment change suggesting partial response to PPIs (new treatment added to PPI, increased PPI dose, or switching PPI) during the subsequent 6 months were identified as potential cases and confirmed after manual review of each patient's complete computer medical record including free-text comments. Patients without these treatment changes were study controls. A nested case-control analysis was conducted using logistic regression. RESULTS: The proportion of newly diagnosed GERD patients with partial response to PPI therapy was 18.6% (1201/6453). Partial response was associated with female gender (odds ratio [OR]: 1.20; 95% confidence interval [CI]: 1.05-1.37), anxiety or depression (OR: 1.15; 95% CI: 1.00-1.31), and prescription of ≥ 6 drugs in the month before GERD diagnosis (OR: 1.42; 95% CI: 1.14-1.78). Among new PPI users (n = 2907), partial response was associated with esophageal ulcer or Barrett's esophagus at initial diagnosis (OR: 3.14; 95% CI: 1.60-6.17). CONCLUSIONS: Approximately one in five newly diagnosed patients with GERD appear to have a partial response to PPI therapy. Female gender, polymedication, and a severe initial diagnosis may be associated with partial response. SN - 1502-7708 UR - https://www.unboundmedicine.com/medline/citation/22519917/Gastroesophageal_reflux_disease_in_primary_care:_using_changes_in_proton_pump_inhibitor_therapy_as_an_indicator_of_partial_response_ L2 - http://www.tandfonline.com/doi/full/10.3109/00365521.2012.679682 DB - PRIME DP - Unbound Medicine ER -