Use of anti-secretory medication: A population-based cohort study

Department of Medical Gastroenterology, Odense University Hospital, Odense C, Denmark.
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.73). 10/2004; 20(5):577-83. DOI: 10.1111/j.1365-2036.2004.02120.x
Source: PubMed


Total use of anti-secretory medication (H2 blockers and proton pump inhibitors) is increasing rapidly, but knowledge of factors related to the increasing use is sparse.
To describe development in the use of anti-secretory medication between 1993 and 2002 at a population level.
We extracted data on use of anti-secretory medication (H2-blockers and proton pump inhibitors) and ulcerogenic drugs, demographic data, and data on gastroscopy and endoscopically verified oesophagitis and peptic ulcer diagnoses, from three large population-based databases covering the County of Funen, Denmark 1990-2002 (population 470,000).
Between 1993 and 2002 incidence of first time users was stable at 16.7/1000 persons/year. Total amount of consumed anti-secretory medication increased from 10.5 DDD/1000 persons/day to 25.2 DDD/1000 persons/day. Ninety per cent of the increase was related to long-term use of anti-secretory medication (> or = 180 DDD/patient/year). In 1993 21% of the anti-secretory medication was used by patients with oesophagitis, this increased to 28% in 2002. The proportion of medication used by peptic ulcer patients decreased from 29% in 1993 to 19% in 2002.
Total use of anti-secretory medication increased as a result of more extensive long-term use, and most of the medication was used by patients without diagnosed peptic ulcer or oesophagitis.

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    • "In the western world, proton pump inhibitors (PPIs) are second only to statins in expenditures, and antisecretory medication constitutes a substantial part of the medical budget in the Denmark and other western countries [1] [2] [3]. Most of the increased use of antisecretory medication is accounted for by long-term users [4] [5]. "
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    ABSTRACT: Objective. To investigate whether patients on long-term antisecretory medication need to continue treatment to control symptoms. Methods. A double-blinded randomised placebo-controlled trial in general practices in Denmark. Patients aged 18-90 who were treated with antisecretory drugs on a long-term basis were randomized to esomeprazole 40 mg or identical placebo. Outcome measures were time to discontinuation with trial medication due to failed symptom control analysed as survival data. The proportion of patients stopping trial medication during the one-year follow-up was estimated. Results. A total of 171 patients were included with a median prior duration of antisecretory treatment of four years (range: 0.5 to 14.6 years). 86 patients received esomeprazole 40 mg and 85 patients received placebo. At 12 months, statistically significantly more patients in the placebo group had discontinued (73% (62/85)) compared with the esomeprazole group (21% (18/86); p < 0.001). Conclusions. Long-term users of antisecretory drugs showed a preference for the active drug compared to placebo. However, 27% of patients continued on placebo throughout the study and did not need to reinstitute usual treatment. One in five patients treated with esomeprazole discontinued trial medication due to unsatisfactory symptom control. Discontinuation of antisecretory treatment should be considered in long-term users of antisecretory drugs. This trial is registered with Trial registration ID: NCT00120315.
    08/2015; 2015(4):175436. DOI:10.1155/2015/175436
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    • "Neither cimetidine nor nizatidine ranked among the top 200 drugs sold in 2007. [218] Although this liberal use of PPI has been recently recommended by many guidelines for dyspepsia [219] [220], it is well documented that these drugs are often inappropriately prescribed for minor symptoms and without clear indications, where the effects of acid-suppressive therapy is controversial [212] [214] [221] [222] [223] [224] [225]. As a result, a large proportion of patients currently prescribed PPI do not have acid-related symptoms and thus, have no true indication for such therapy. "
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    ABSTRACT: The homeopathic model applies the secondary action or vital reaction of the organism as a therapeutic method and thus prescribes treatment by similitude, which consists in administering to ill individuals substances that cause similar symptoms in healthy individuals. The vital, homeostatic or paradoxical reaction of the organism might be explained scientifically by means of the rebound effect of modern drugs, which might cause fatal iatrogenic events after discontinuation of antipathic (a term used in alternative medicine for palliative treatment, also known as enantiopathic) treatment. Although the rebound effect is studied by modern pharmacology, it is poorly communicated to and discussed among healthcare professionals, who are thus deprived of information needed for the safe management of modern drugs. This article presents an up-to-date review on the rebound effect of modern drugs that grounds the homeopathic principle of healing and calls the attention of doctors to this type of adverse effect that is usually unnoticed. The rebound effect of modern palliative drugs, which was pointed out by Hahnemann more than two centuries ago, might cause fatal adverse events and is illustrated by the examples of acetylsalicylic acid, anti-inflammatory agents, bronchodilators, antidepressants, statins, proton-pump inhibitors, etc. Although the rebound effect is expressed by a small fraction of (susceptible) individuals and might be avoided by gradual tapering of antipathic drugs, it exhibits epidemiologic importance as a function of the massive use of such palliative drugs and the lack of knowledge in its regard.
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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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    ABSTRACT: The prevalence of gastroesophageal reflux disease (GERD) increases with age and elderly are more likely to develop severe disease. Older patients often complain of less severe or frequent heartburn than younger patients and they may present with atypical symptoms such as dysphagia, weight loss, or extraesophageal symptoms. Proton pump inhibitors (PPIs) are central in the management of GERD and are unchallenged with regards to their efficacy. They are considered safe and more effective than histamine receptor antagonists for healing esophagitis and for preventing its recurrence using a long term maintenance treatment. PPI have minimal side effects and few slight drug interactions and are considered safe for long term treatment. Pantoprazole is significantly effective both for acute and long-term treatment with excellent control of relapse and symptoms. It is well tolerated even for long-term therapy and its tolerability is optimal. Pantoprazole shows to have minimal interactions with other drugs because of a lower affinity for cytocrome P450 than older PPIs. Although the majority of elderly has concomitant illnesses and receive other drugs, this does not adversely effect the efficacy of pantoprazole because of its pharmacokinetics, which are independent of patient age. Clinical practice suggests that a low dose maintenance of PPIs should be used in older patients with GERD.
    Clinical Interventions in Aging 02/2007; 2(1):85-92. DOI:10.2147/ciia.2007.2.1.85 · 2.08 Impact Factor
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