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Esophagus

Gastroesophageal reflux disease in primary care: Using changes in proton pump inhibitor therapy as an indicator of partial response

, , , &
Pages 751-761 | Received 26 Jan 2012, Accepted 19 Mar 2012, Published online: 23 Apr 2012
 

Abstract

Objective. Up to one-third of patients with gastroesophageal reflux disease (GERD) in primary care have residual symptoms despite proton pump inhibitor (PPI) therapy. We aimed to characterize partial response to PPIs among adult patients in UK primary care. Material and methods. Newly diagnosed GERD patients aged 20–79 years who were prescribed PPI for treatment of GERD were identified in The Health Improvement Network. Those with a treatment change suggesting partial response to PPIs (new treatment added to PPI, increased PPI dose, or switching PPI) during the subsequent 6 months were identified as potential cases and confirmed after manual review of each patient's complete computer medical record including free-text comments. Patients without these treatment changes were study controls. A nested case–control analysis was conducted using logistic regression. Results. The proportion of newly diagnosed GERD patients with partial response to PPI therapy was 18.6% (1201/6453). Partial response was associated with female gender (odds ratio [OR]: 1.20; 95% confidence interval [CI]: 1.05–1.37), anxiety or depression (OR: 1.15; 95% CI: 1.00–1.31), and prescription of ≥6 drugs in the month before GERD diagnosis (OR: 1.42; 95% CI: 1.14–1.78). Among new PPI users (n = 2907), partial response was associated with esophageal ulcer or Barrett's esophagus at initial diagnosis (OR: 3.14; 95% CI: 1.60–6.17). Conclusions. Approximately one in five newly diagnosed patients with GERD appear to have a partial response to PPI therapy. Female gender, polymedication, and a severe initial diagnosis may be associated with partial response.

Acknowledgements

Drs Chris Winchester and Nesta Hughes, from Oxford PharmaGenesis Ltd, provided writing and editorial assistance from the outline stage of the manuscript through to submission, which was funded by AstraZeneca R&D Mölndal. Drs Chris Winchester and Nesta Hughes were not involved in writing the protocol, developing computer algorithms, extracting, managing or analyzing the data. Ana Ruigomez and Luis A. García Rodríguez were involved in all the phases of the study: writing the protocol, developing of computer algorithms, data extraction, data management and analysis, interpretation of results, and writing of the manuscript. Saga Johansson and Börje Wernersson were involved in designing the protocol and writing the manuscript. Oscar Fernández Cantero was primarily involved in creating computer algorithms and extracting, managing and analyzing data. Ana Ruigómez, Oscar Fernández Cantero and Luis A. García Rodríguez are employees of CEIFE. This study was funded by an unrestricted research grant from AstraZeneca Research and Development Mölndal, Sweden. The sponsors played no part in the design or conduct of the study.

Declaration of interest: Luis A. García Rodríguez has received consultancy fees from AstraZeneca. Saga Johansson and Börje Wernersson are employees of AstraZeneca R&D, Mölndal, Sweden. Preliminary data were presented previously at United European Gastroenterology Week 2010, 23–27 October 2010, Barcelona, Spain, and published as an abstract in Gut 2010; 59 (Suppl 3): A86.

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