Clinical ResearchStep-down management of gastroesophageal reflux disease☆,☆☆
Section snippets
Materials and methods
The population studied was composed of outpatients in the general medicine clinics at the Veterans Administration (VA) Albuquerque Regional Medical Center. A list of patients in whom PPIs were prescribed was generated through the pharmacy module of VISTA, the computer database of the medical center. Because PPIs were also prescribed for non-GERD indications, such as ulcer disease or Helicobacter pylori eradication, only those prescriptions filled for greater than 8 weeks were considered. The
Results
Three hundred seventy-six patients were identified as having been prescribed PPIs for 8 weeks or longer from our medical center. One hundred fifty-five consecutive patients were evaluated in the GERD clinic. Of these, 82 were excluded (Table 1); the largest group of patients excluded were those still symptomatic despite PPI use.Symptomatic despite PPI therapy Heartburn or acid regurgitation 7 Dyspepsia 22 Peptic stricture 17 Extraesophageal GERD 11 Anemia or occult GI bleeding 10 PPI use
Discussion
This study of patients with reflux symptoms treated with PPIs in a primary care setting revealed that more than half could be maintained in remission without PPI therapy. Twenty-seven percent required no medication to treat their reflux symptoms, and the remaining 73% in whom step-down was successful required less expensive forms of anti-GERD therapy. Younger subjects required PPIs to alleviate recurrent symptoms more often than older subjects. A dominant symptom of heartburn also predicted the
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Address requests for reprints to: John M. Inadomi, M.D., VA Ann Arbor Medical Center (111-D), 2215 Fuller Road, Ann Arbor, Michigan 48105. e-mail: [email protected]; fax: (734) 761-7549.
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Supported by a Junior Faculty Development Award from the American College of Gastroenterology (to J.M.I.) and by a grant from the Centers for Disease Control (to A.S.).