Acid suppression medications have become one of the most commonly prescribed classes of therapeutic agents. However, little data exists describing the chronic use of these agents among a general population.
In this study, a team from the United States sought to determine the patterns of use of proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs) in clinical practice. In addition, the team assessed the distribution and severity of symptoms in patients prescribed these therapies.
They used pharmacy billing data from insurers to identify patients on chronic (>90 days) PPIs and H2RAs.
|A relevant GI diagnosis was found for only 61% of patients prescribed chronic acid suppression therapy.|
|American Journal of Gastroenterology|
The researchers obtained data on patient demographics, diagnoses, frequency of office visits, and information about diagnostic testing from the billing databases.
In addition, a questionnaire addressing recent upper GI symptoms, over-the-counter medication use, and gastroenterologist consultations was sent to 35% of eligible patients (n = 1139).
The research team compared the diagnoses of patients on chronic therapy with those of the general population.
Additionally, they compared the frequency of symptoms and diagnostic testing between those prescribed H2RAs and PPIs.
From a total of 168,727 adult patients, 4684 were prescribed chronic acid suppression therapy, with 47% taking H2RAs and 57% taking PPIs.
However, a relevant GI diagnosis was found for only 61% of patients; mainly for gastroesophageal reflux disease (38%) and dyspepsia (42%), with many patients carrying both diagnoses.
The survey revealed that more than 30% of responders experienced heartburn or reflux more than twice a week. More than half experienced symptoms of dyspepsia at least once a week.
However, diagnostic testing was uncommon, with only 19% having undergone esophagogastroduodenoscopy within the previous 2 years.
Dr Brian Jacobson's team concluded, "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".