PPIs Alone Cannot Reduce GERD Burden

New prescriptions of proton pump inhibitors (PPIs) are typically appropriately prescribed for patients with gastroesophageal reflux disease (GERD), but physicians often fail to discuss lifestyle changes with their patients, according to new findings.

Because long-term use of PPIs may lead to serious adverse effects, including kidney damage and cardiovascular events, lifestyle modifications are highly recommended to reduce the disease burden on patients with GERD.

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The researchers, who presented their findings at Digestive Disease Week 2018 this week, aimed to determine whether primary care providers are adhering to the American College of Gastroenterology (ACG) Guidelines regarding appropriate use of PPIs and discussion of lifestyle modification.

To conduct their study, the researchers randomly selected 591 adult patients who were newly prescribed PPIs in an outpatient clinic in Illinois from January 1, 2016, to June 30, 2016.

The researchers then analyzed data from 100 participants who had GERD and at least 1 follow-up visit at 8 weeks.

Demographic data, type and dose of PPI at initiation of treatment, whether diet and lifestyle modifications were discussed, and whether appropriate intervention/discontinuation of treatment was discussed at the first follow-up visit at 8 weeks were also considered.

After the 8-week follow-up, the researchers found that 97 participants had received pantoprazole and 3 had received omeprazole. Overall, 91 participants had received appropriate dosing at baseline. Only 22 participants had been offered step-down or step-up dosing after 8 weeks, while 80% of participants continued taking PPIs after 8 weeks.

“In patients with GERD, while PPIs were initiated at the appropriate dose as per ACG guidelines, lifestyle modifications were seldom discussed by primary care providers,” the researchers concluded.

“Majority of patients continued to be on PPIs after 8 weeks. There is a need to educate primary care providers about the appropriate use of PPIs and the role of diet and lifestyle modification in patients with GERD.”

—Amanda Balbi

Reference:

Elkhouly M, Kotwal V, Attar BM, Trick W, Diep L. (In)appropriate use of proton pump inhibitors in gastroesophageal reflux disease. Paper presented at: Digestive Disease Week 2018; June 2-5, 2018; Washington, DC. https://ep70.eventpilot.us/web/page.php?page=IntHtml&project=DDW18&id=2924903. Accessed June 5, 2018.

Listen to our podcast with Dr Jamie Koufman about PPI use: