Long term acid suppressing treatment in general practice

Abstract Objective: To determine the current practice in selected general practices for prescribing long term (>6 months) treatment to suppress gastric acid secretion. Setting: Seven general practices in the Harrow area that always or usually refer to Northwick Park Hospital. Subjects--60 148 pat...

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Bibliographic Details
Published in:	BMJ Vol. 308; no. 6932; pp. 827 - 830
Main Authors:	Ryder, Stephen D, O'Reilly, Sean, Miller, Rebecca J, Ross, Juliette, Jacyna, Meron R, Levi, A Jonathon
Format:	Journal Article
Language:	English
Published:	England British Medical Journal Publishing Group 26-03-1994 British Medical Association BMJ Publishing Group LTD BMJ Group
Subjects:	Abdominal pain Abdominal Pain - etiology Abdominal Pain - therapy Adolescent Adult Aged Aged, 80 and over Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Child Child, Preschool Cimetidine - therapeutic use Drug prescriptions Drug Utilization Duodenal diseases Duodenal ulcer Duodenal Ulcer - drug therapy Duodenal Ulcer - metabolism England Esophageal Diseases - drug therapy Esophageal Diseases - metabolism Family Practice Famotidine - therapeutic use Female Gastric Acid - metabolism Gastrointestinal diseases General practice Humans Long-Term Care Male Middle Aged Nizatidine - therapeutic use Nonsteroidal antiinflammatory agents Patient Satisfaction Peptic ulcer Prescription drugs Ranitidine - therapeutic use Symptoms
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Summary:	Abstract Objective: To determine the current practice in selected general practices for prescribing long term (>6 months) treatment to suppress gastric acid secretion. Setting: Seven general practices in the Harrow area that always or usually refer to Northwick Park Hospital. Subjects--60 148 patients on lists of the general practices. Design: Identification of patients receiving long term treatment through repeat prescribing data, followed by a manual and computer survey of patients' notes for indications and investigations. Patient compliance and views on treatment were sought by a postal questionnaire. Main outcome measures: Indications for treatment, treatment given, investigations undertaken before and during treatment. Results: 492 patients (0.82% of the population) were taking long term acid suppressing treatment. The most common diagnosis was duodenal ulcer disease (183 (37%) of all patients); oesophageal disease (118 (24%)) was also common. 93 patients (19%) were treated for abdominal pain where no diagnosis had been reached or who had only a diagnosis of gastritis on endoscopy. Ranitidine was prescribed in 394 (80%) patients. 298 (74%) patients found treatment helpful, but 108 (27%) had a poor understanding of their diagnosis. 317 patients (78%) took their drug as prescribed. 37 patients were also taking prescribed non-steroidal anti-inflammatory drugs and an additional 43 patients took regular aspirin or ibuprofen without prescription. Conclusions: Long term acid suppressing treatment is common, and a substantial number of patients are taking these drugs long term without a diagnosis having been reached. It is hoped that protocols for investigation and treatment will improve these figures. Patients need to be better informed about their disease and the possible adverse effects of taking non-steroidal antiinflammatory drugs in acid related upper gastrointestinal disease.
Bibliography:	ark:/67375/NVC-ZJ9167G8-L istex:7C0AF718EFAE5443F11E73716652DF7F05F7C668 local:bmj;308/6932/827 href:bmj-308-827.pdf PMID:8167491 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0959-8138 1468-5833 1756-1833
DOI:	10.1136/bmj.308.6932.827