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Who is using chronic acid suppression therapy and why?
Brian C Jacobson1, Timothy G Ferris, Tara L Shea
1Department of Medicine, Gastroenterology Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
The American Journal of Gastroenterology
|January 16, 2003
Summary
Many patients use acid suppression medications like proton pump inhibitors (PPIs) and histamine H2 receptor antagonists (H2RAs) long-term. A significant number lack clear diagnoses, experience frequent symptoms, and undergo limited testing, indicating care improvement needs.
Area of Science:
- Gastroenterology
- Pharmacology
- Health Services Research
Background:
- Acid suppression medications, including proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs), are widely prescribed.
- Limited data exists on the chronic use patterns and outcomes of these agents in general populations.
Purpose of the Study:
- To investigate the patterns of chronic PPI and H2RA use in a large healthcare network.
- To determine the prevalence and severity of gastrointestinal (GI) symptoms in patients on these therapies.
- To assess the diagnostic workup for patients receiving long-term acid suppression.
Main Methods:
- Utilized pharmacy billing data from two insurers to identify patients on chronic acid suppression (>90 days).
- Extracted demographic, diagnostic, and procedural data from billing databases.
- Administered a questionnaire to a subset of patients regarding GI symptoms, medication use, and consultations.
Main Results:
- 2.8% of 168,727 adult patients received chronic acid suppression therapy (47% H2RAs, 57% PPIs).
- Only 61% of patients had a relevant GI diagnosis in billing data; common diagnoses included GERD and dyspepsia.
- Over 30% reported frequent heartburn/reflux, and over half experienced weekly dyspepsia symptoms; esophagogastroduodenoscopy was uncommon (19% within 2 years).
Conclusions:
- Chronic acid suppression therapy is common, but a substantial proportion of patients lack clear upper GI diagnoses.
- High symptom burden and infrequent diagnostic testing suggest opportunities to optimize care for patients on long-term acid suppression.