How Do Primary Care Physicians Use Long-Term Acid Suppressant Drugs?

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Original Research

How Do Primary Care Physicians Use Long-Term Acid Suppressant Drugs?

J Fam Pract. 2002 March;51(3):241-245

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References

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There is little difference in the pattern of ASD prescribing for patients with ulcer, GERD, or functional dyspepsia. This similarity is particularly interesting because most studies of patients with functional dyspepsia have shown no benefit with the use of ASDs or with the eradication of H pylori.^17-22 In these patients it may be sensible to taper the use of ASDs gradually, supported by antacid use; to explore the level of psychosocial distress; and to advise on lifestyle improvement.²³ Long-term medication was prescribed as a preventive measure for the remaining 25% of all long-term users and to patients not given an endoscopy or barium study. The guidelines advise further investigation after several empirical treatments and again before a long-term ASD is prescribed.

One notable finding was that the patient’s sex appeared to influence whether investigations were ordered. The fact that ulcer disease is overall less often diagnosed in women might explain why the GPs did not perform further diagnostic investigations in women. Anxiety for endoscopy in men or women is another reason for not having a confirmed working diagnosis. A small number of anxious patients who have underlying ulcer disease might benefit from a test-and-treat approach to H pylori infection. However, serology cannot differentiate between either present or past H pylori infection and between ulcer or nonulcer disease.

Patients often experience a fast relapse of symptoms after discontinuation of therapy that may be related to rebound acid hypersecretion.^24-26 It is possible that the prescription pattern of physicians in a subset of dyspeptic patients, especially in those with acid-related dyspepsia, leads to dependence on long-term therapy.

Conclusions

The use of ASDs, especially proton-pump inhibitors, is becoming increasingly common. In general practice in the Amsterdam region, 2% of patients used long-term ASDs. Patients with ulcer disease may stop taking ASDs after apparently successful H pylori eradication. Other patients require additional proof of underlying disease and H pylori status to determine the subsequent treatment approach. Tapering strategies in patients with mild reflux disease or functional dyspepsia need to be developed. Research is also needed in the general practice setting to develop strategies for tapering ASDs in chronic dyspeptic patients.