Who is using chronic acid suppression therapy and why?
ABSTRACT 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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ABSTRACT: In patients with dyspepsia, a common initial management strategy in primary care is to prescribe a course of empiric antisecretory therapy. Ranitidin and omeprazole as antisecretory agents have been proven effective for treatment of dyspepsia. This research was aimed to evaluate the effect of omeprazole and ranitidine by using Nepean Dyspepsia Index (NDI) which was translated and validated in Indonesian language. Fifty healthy persons were asked to complete the Indonesia translated NDI(NDII) and Short Form(SF)-36, which was previously validated. Cronbach' s alpha and test-retest were performed for reliability analysis. Spearman's rank correlation was used to assess validity. P -value <0.03 was considered statistically significant. The results concluded that NDIl can be used in dyspepsia patients who understand Indonesian language. The number of 104 subjects with a clinical diagnosis of dyspepsia according to the inclusion and exclusion criteria were recruited and randomized to receive ranitidine 150 mg twice daily and omeprazole 20 mg twice daily. Symptoms of dyspepsia were evaluated by using NDIl at baseline one week after treatment. The outcomes of omeprazole and ranitidine were evaluated by comparing improved NDIl score in 5 domains (tension, activities, eating/drinking, knowledge/control and work/study). The mean of age in the subjects was 47 years old that consisted of 36% male. After one week treatment, the NDIl dyspepsia patients score in omeprazole treated group was not significantly different from that in ranitidine treated group. The effect of omeprazole was not better than ranitidine when it was given as empirical treatment for dyspepsia patients in primary care.
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ABSTRACT: Rationale: H2RA use is common and may act directly on the heart through myocardial H2 receptors or indirectly through changes in pulmonary vascular resistance. Objective: To determine the relationship between histamine H2 receptor antagonist (H2RA) use and right ventricular (RV) morphology. Methods: We studied 4,124 participants in the Multi-Ethnic Study of Atherosclerosis without overt cardiovascular disease who had magnetic resonance imaging (MRI) assessment of RV morphology and ascertainment of medication use. Multivariable linear regression estimated cross-sectional associations between H2RA use and RV morphology after adjusting for demographics, anthropometrics, smoking status, diabetes mellitus and hypertension. Further adjustment for co-medication use, left ventricular (LV) parameters, lung structure and function, renal function, or inflammatory markers were considered in separate models. Analyses in a sub-cohort restricted to H2RA or proton pump inhibitor (PPI) users accounted for confounding by the indication of gastroesophageal reflux disease. Measurements and Main Results: H2RA use was associated with lower RV mass (-0.7 g, 95% confidence interval (CI): -1.2 to -0.2 g, p=0.004) and smaller RV end-diastolic volume (EDV) (-4.2 mL, 95% CI: -7.2 to -1.2 mL, p=0.006). This relationship was unchanged with adjustment for co-medication use, lung structure and function, renal function, and inflammation. The relationship with RV mass was independent of LV mass. Results were similar in a smaller sub-cohort restricted to PPI and H2RA users. Conclusion: H2RA use was associated with lower RV mass and smaller RVEDV. This finding is novel. Additional study of histamine and H2 receptors in cardiopulmonary diseases affecting the RV may have direct clinical relevance.10/2014; DOI:10.1513/AnnalsATS.201407-344OC
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ABSTRACT: Potent gastric acid suppression using proton pump inhibitors (PPIs) is common in clinical practice but may have important effects on human health that are mediated through changes in the gastrointestinal microbiome. In the esophagus, PPIs change the normal bacterial milieu to decrease distal esophageal exposure to inflammatory gram-negative bacteria. In the stomach, PPIs alter the abundance and location of gastric Helicobacter pylori and other bacteria. In the small bowel, PPIs cause polymicrobial small bowel bacterial overgrowth and have been associated with the diagnosis of celiac disease. In the colon, PPIs associate with incident but not recurrent Clostridium difficile infection. Copyright © 2014 Elsevier Inc. All rights reserved.Clinics in Laboratory Medicine 12/2014; DOI:10.1016/j.cll.2014.08.008 · 1.35 Impact Factor