Pediatric gastroesophageal reflux disease and acid-related conditions: trends in incidence of diagnosis and acid suppression therapy

Figures & data

Table 1. Annual incidence rate of the diagnosis of GERD/ARC in pediatric patients by age group.

All pediatric patients (ages 0–17)
Year*	0–1	2	3–5	6–11	12–17
2000	3.40	0.75	0.62	0.79	0.94
2005	12.30	1.11	0.93	1.09	1.26
% Change	262	48	50	38	34
Pediatric patients treated with H2RAs or PPIs
Year*	0–1	2	3–5	6–11	12–17
2000	1.50	0.17	0.10	0.13	0.29
2005	8.10	0.33	0.28	0.40	0.46
% Change	440	94	180	208	59

*Incidence rates for each year-age group combination were calculated as the number of individuals diagnosed with GERD divided by the total number of individuals in each year-age group category.

H₂RA, histamine-2 receptor antagonists; PPI, proton pump inhibitor.

Table 2. Baseline characteristics of pediatric GERD/ARC patients diagnosed by GI specialists and primary care physicians (PCPs).

Baseline characteristics*	GI specialist	PCP^†	p-value^‡
Sample size, n	1,985	19,486
Female, %	51.8%	52.5%	0.534
Age, mean (SD)	10.5 (5.1)	9.9 (5.2)	<0.001^§
Number of comorbid conditions, mean (SD)	1.78 (1.50)	1.01 (1.22)	<0.001^§
Healthcare utilization, %
Hospitalization	9.0%	3.7%	<0.001^§
ER visit	21.2%	14.6%	<0.001^§
Outpatient visit	51.4%	26.8%	<0.001^§
Number of outpatient visits, mean (SD)	1.51 (3.54)	0.58 (1.78)	<0.001^§
Relevant medication use, %
H2 antagonists	15.5%	4.3%	<0.001^§
PPIs	19.1%	2.6%	<0.001^§
Promotility agents	2.9%	0.6%	<0.001^§
Healthcare costs, mean (SD)
Total drug cost	$400 ($1,497)	$169 ($962)	<0.001^§
Total medical cost	$4,091 ($25,835)	$1,268 ($11,200)	<0.001^§
Total healthcare cost	$4,492($26,299)	$1,437 ($11,330)	<0.001^§

*Baseline characteristics were measured over the 6 months prior to the first GERD/ARC diagnosis.

^†PCP (primary care physician) included family practice, internal medicine, general preventive medicine and pediatrician.

^‡Wilcoxon tests were used for comparing continuous variables; chi-squared tests were used for comparing categorical variables.

^§Significant at 5% level.

GERD, gastroesophageal reflux disease; ARC, acid-related conditions; H₂RA, histamine-2 receptor antagonists; PPI, proton pump inhibitor; GI specialist, gastrointestinal specialist.

Figure 1. Distribution of pediatric GERD/ARC patients initiated on H₂RAs and PPIs (1999–2005). GERD, gastroesophageal reflux disease; ARC, acid-related conditions; H₂RA, histamine-2 receptor antagonists; PPI, proton pump inhibitors.

Table 3. Baseline characteristics of pediatric GERD/ARC patients initiated on H₂RAs and PPIs.

Baseline characteristics*	H2RAs	PPIs	p-value^†
Sample size, n	4,729	4,600
Female, %	51.6%	52.9%	0.218
Age, mean (SD)	9.3 (5.5)	11.5 (4.8)	<0.001^‡
Number of comorbid conditions, mean (SD)	1.4 (3.2)	1.7 (4.1)	<0.001^‡
Healthcare utilization, %
Hospitalization, GERD related	2.5%	4.0%	<0.001^‡
Hospitalization, any cause	8.4%	10.0%	0.007^‡
ER visit, GERD related	3.7%	3.8%	0.921
ER visit, any cause	21.9%	22.4%	0.608
Outpatient visit, GERD related	11.6%	21.5%	<0.001^‡
Outpatient visit, any cause	41.4%	53.2%	<0.001^‡
Number of outpatient visits, mean (SD)	1.0 (2.9)	1.5 (3.7)	<0.001^‡
Healthcare costs, mean (SD)
Total drug cost	$201 ($1,239)	$309 ($1,221)	<0.001^‡
Total medical cost	$3,686 ($38,518)	$4,122 ($24,976)	<0.001^‡
Total healthcare cost	$3,887 ($38,585)	$4,431 ($25,190)	<0.001^‡

*Baseline characteristics were measured over the 6 months prior to the initiation of H₂RAs or PPIs.

^†Wilcoxon tests were used for comparing continuous variables; chi-squared tests were used for comparing categorical variables.

^‡Significant at 5% level.

GERD, gastroesophageal reflux disease; ARC, acid-related conditions; H₂RA, histamine-2 receptor antagonists; PPI, proton pump inhibitor.

Table 4. Treatment pattern of pediatric GERD/ARC patients initiated on H₂RAs and PPIs.

Treatment pattern	H2RAs	PPIs
Sample size, n	4,729	4,600
Discontinuation of index therapy*
1-month discontinuation rate^† (%)	71.0%	51.7%
Median days on index therapy during first year^‡	30	60
Switching of index therapy^§
1-month switching rate^† (%)	4.6%	0.5%

*Discontinuation was defined as having a 30-day gap between index drug (H₂RA or PPI) supplies.

^†Kaplan–Meier method was used to estimate rates of discontinuation and switching.

^‡Patients were required to be continuously enrolled for the first year after index date.

^§Switching was defined as having a prescription for alternative drug (i.e., H₂RAs for PPI patients, and PPIs for H₂RA patients) within 14 days from the end of last index drug supply. Switching patients were required to discontinue index therapy.

GERD, gastroesophageal reflux disease; ARC, acid-related conditions; H₂RA, histamine-2 receptor antagonists; PPI, proton pump inhibitor.

Table 5. Selected predictors of PPIs vs. H₂RAs as first line therapy for pediatric GERD/ARC Patients*,^†.

Potential risk factors^‡	Coefficient	Odds ratio	95% confidence limits		p-value
Age group
Age 0 year	–1.78	0.17	0.12	0.25	<0.001**
Age 1 year	–1.67	0.19	0.15	0.24	<0.001**
Age 2 years	–1.22	0.30	0.22	0.40	<0.001**
Age 3–5 years	–1.00	0.37	0.31	0.44	<0.001**
Age 6–11 years	–0.52	0.59	0.53	0.66	<0.001**
Age 12–17 years as reference
Female	–0.05	0.95	0.87	1.04	0.280
Index year^§
Index year 1999	–1.48	0.23	0.15	0.34	<0.001**
Index year 2000	–1.42	0.24	0.19	0.30	<0.001**
Index year 2001	–1.19	0.30	0.26	0.36	<0.001**
Index year 2002	–0.97	0.38	0.33	0.44	<0.001**
Index year 2003	–0.72	0.49	0.42	0.56	<0.001**
Index year 2004	–0.38	0.69	0.60	0.79	<0.001**
Index year 2005 as reference
Deyo Charlson Comorbidity Index	0.00	1.00	0.88	1.13	0.986
Healthcare utilization
Hospitalization, GERD related	–0.16	0.85	0.63	1.15	0.291
ER visit, GERD related	–0.43	0.65	0.51	0.83	0.001**
Outpatient visit, GERD related	0.30	1.35	1.17	1.57	<0.001**
Allergist visit	0.34	1.41	1.00	2.00	0.053
ENT – otolaryngologist visit	0.56	1.75	1.44	2.12	<0.001**
Pulmonologist visit	0.40	1.50	1.09	2.06	0.014**
Relevant medication use
Promotility agents	0.51	1.67	1.14	2.45	0.009**

*A subset of covariates are shown in this table.

†Based on logistic regression.

^‡Risk factors were measured on the index date or over the 6-month baseline period.

^§Index year referred to the calendar year in which the index date falls.

**Significant at 95% level.

GERD, gastroesophageal reflux disease; ARC, acid-related conditions; H₂RA, histamine-2 receptor antagonists; PPI, proton pump inhibitor.