Stomach Flu

Summary text
During 4 years of observation, as part of the ProGERD cohort study, the majority of patients with GERD were receiving long-term treatment with a PPI. Continuous PPI treatment was more common than on-demand PPI treatment. The proportion of patients taking PPIs remained constant during 4 years of observation.

Key findings

Over 70% of GERD patients in this study were receiving long-term PPI treatment, and 80% of patients taking PPIs in year 1 were still doing so in year 4.The predominant treatment pattern was continuous PPI therapy, followed by on-demand PPI use.Patients taking a PPI on a continuous basis had reflux esophagitis or a longer duration of disease, a higher symptom load, and a greater likelihood of extra-esophageal symptoms at baseline than patients taking PPIs on demand or no GERD medication at all.Extended abstract

Background: Long-term treatment with proton pump inhibitors (PPIs) is common in patients with gastroesophageal reflux disease (GERD). Recently, on-demand PPI treatment has been shown to be an effective alternative to continuous PPI treatment for long-term symptom control in some GERD patients. However, data on the patterns of long-term GERD medication use are extremely limited.

Aim: The 10-year ProGERD cohort study aims to describe the endoscopic, histological, and symptomatic progression of gastroesophageal reflux disease in patients under routine care. Using data from the ProGERD study, this analysis aimed to determine the pattern of long-term medication use in patients with GERD over 4 years.

Methods: Primary care patients diagnosed with GERD were recruited as part of the ProGERD study. Following endoscopy, patients were categorized as having non-erosive reflux disease (NERD), mild (Los Angeles [LA] grade A or B) erosive reflux disease (reflux esophagitis) or severe (LA grade C or D) erosive reflux disease. Patients received esomeprazole treatment for up to 8 weeks then entered the ongoing 10-year observational phase, during which drug therapy is prescribed as necessary by participating primary care physicians (choice of therapy was left to the physician’s discretion). GERD symptoms and medication usage are assessed yearly using patient questionnaires. Logistic regression analyses were used to assess associations between patient characteristics and medication. This paper reports results from the first 4 years of the study.

Results: The overall ProGERD population included 6215 patients (53% male; median age 54 years). The proportion of patients taking any GERD medication remained at over 70% from years 1 to 4 (74%, 74%, 73%, and 71% for years 1, 2, 3 and 4, respectively). Overall, most of these patients were taking PPIs (79%, 84%, 85%, and 87%, respectively). Continuous PPI therapy was more frequent than on-demand PPI use in all groups (Table 1). The percentage of patients taking continuous PPI therapy increased with the severity of disease (Table 1). Over 80% of patients taking a PPI in year 1 were still doing so in year 4. Most patients (62–79%) receiving continuous PPI therapy in year 1 were still receiving continuous PPI therapy in year 4. Approximately half (49–53%) of patients taking on-demand PPI therapy in year 1 were still doing so in year 4; 22–34% of patients taking on-demand PPI therapy in year 1 had switched to continuous PPI therapy by year 4. Patients taking continuous PPIs tended to be those with a longer duration of disease, extra-esophageal symptoms and a higher symptom load compared with patients taking other or no medication. Severe erosive reflux disease was strongly associated with continuous PPI therapy (odds ratio 3.24 [95% confidence interval: 2.30, 4.58], p < 0.001 versus on-demand therapy).

Conclusions: Over 70% of patients in this study were receiving long-term PPI therapy, and continuous PPI therapy was more common than on-demand PPI use. The proportion of patients taking continuous PPI therapy remained constant over the 4-year observation period.

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