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

Odense University Hospital, Odense, South Denmark, 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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    • "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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