Who is Using Chronic Acid Suppression Therapy and Why?

Department of Medicine, Gastroenterology Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
The American Journal of Gastroenterology (Impact Factor: 10.76). 01/2003; 98(1):51-8. DOI: 10.1111/j.1572-0241.2003.07186.x
Source: PubMed


Acid suppression medications have become one of the most commonly prescribed classes of therapeutic agents. Because little data exists describing the chronic use of these agents among a general population, we sought to determine the patterns of use of proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs) in clinical practice, as well as the distribution and severity of symptoms in patients prescribed these therapies.
Pharmacy billing data from two insurers were used to identify all patients on chronic (>90 days) PPIs and H2RAs within a large, eastern Massachusetts provider network. Patient demographics, diagnoses, frequency of office visits, and information about diagnostic testing were obtained from billing databases. A questionnaire addressing recent upper GI symptoms, over-the-counter medication use, and gastroenterologist consultations was mailed to a 1,139 patient subset (35%) of eligible patients. We compared the diagnoses of patients on chronic therapy with those of the general population of the network. We also compared the frequency of symptoms and diagnostic testing between those prescribed H2RAs and PPIs.
From a total population of 168,727 adult patients, we identified 4,684 (2.8%) prescribed chronic acid suppression therapy, with 47% taking H2RAs and 57% taking PPIs (4% filled prescriptions for both simultaneously). A relevant GI diagnosis was found using billing data for only 61% of patients, mainly for gastroesophageal reflux disease (38%) and dyspepsia (42%), with many patients carrying both diagnoses. Our survey (response rate 59%) revealed that more than 30% of responders experienced heartburn or reflux more than twice a week, and more than half experienced symptoms of dyspepsia at least once a week. Diagnostic testing was uncommon, with only 19% having undergone esophagogastroduodenoscopy within the prior 2 yr.
Acid suppression medications were used chronically by a large number of patients within this population. A significant proportion of patients on chronic PPI or H2RA lacked definitive upper GI diagnoses in their billing data. The high symptom burden and low use of diagnostic testing indicates opportunities for improvement in the care of patients on chronic acid suppression therapy.

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    • "There is no consensus or agreed defi nition on what constitutes long term PPIs prescription. The defi nition has varied: from one repeated prescription over 12 months to continuous therapy for periods ranging from 4 to >12 months (Table 1) (Ryder et al 1994; Roberts and Bateman 1995; Rubin et al 1995; Goudie et al 1996; Ahnfeldt-Mollerup et al 1997; Boutet et al 1999; Hungin et al 1999; Prach et al 1999; Vetvik and Straand 2001; Hurenkamp et al 2002; Chen et al 2003; Jacobson et al 2003; Majumdar et al 2003; Lassen et al 2004; Raghunath and Hungin 2004; Tsai et al 2004; Raghunath et al 2005). GERD is a very common complaint when considering the management of treatment with PPIs in the population over 65 years of age. "
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