In patients with gastroesophageal reflux disease (GERD),
proton pump inhibitors (PPIs) are initiated at the appropriate dose but lifestyle
modifications are seldom discussed by primary care providers, and the majority
of patients continue to take PPIs after 8 weeks.

This conclusion, based on results of a retrospective chart
review, was presented at this month’s Digestive Disease Week in Washington D.C.

Mohamed Elkhouly, MD, of John H. Stroger Hospital of Cook
County, Chicago, Illinois, explained that PPIs are the most commonly prescribed
medications for gastroesophageal reflux disease.

They have been reported recently to be associated with
multiple serious side effects including chronic kidney disease, dementia,
infection, osteoporotic fracture, cardiovascular events, and increased
mortality.

It is recommended, therefore, to use the lowest effective
dose of proton pump inhibitors and to avoid unnecessary chronic therapy.

Dr Elkhouly and colleagues set out to examine American
College of Gastroenterology Guidelines by primary care providers regarding the
appropriate use of proton pump inhibitors in patients with gastroesophageal
reflux disease.

The charts of patients with gastroesophageal reflux disease
were examined to determine whether: 1) the proton pump inhibitor was initiated
at a once-daily dose; 2) diet and lifestyle modifications were advised; and 3)
appropriate evaluation/discussion about discontinuation was performed at the
first follow-up visit at 8 weeks.

A total of 591 adult patients were randomly selected. They
were >18 years of age and received new proton pump inhibitor prescriptions
in an outpatient clinic in 2016.

Charts were reviewed for the indication of proton pump
inhibitor therapy. Overall, 100 patients with gastroesophageal reflux
disease who attended at least one follow-up visit at 8 weeks were included in
final analysis.

The analysis included demographic data, type and dose of
gastroesophageal reflux disease at treatment initiation, the type of clinic,
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.

A total of 97 patients received pantoprazole; 3, omeprazole.
Once-daily dosing was initiated in 99 (99%) patients, 91 patients (91%) were
dosed appropriately.

Lifestyle modification was discussed in only 23 patients
(23%). 

At the first follow-up visit after 8 weeks, despite review
of the indication for a proton pump inhibitor in 64 patients, step-down or
step-up according to response was offered to only 22 patients (34.4%). The
majority of patients (80%) continued to be taking a proton pump inhibitor at
the end of the first follow-up visit.

Dr Elkhouly concluded that primary care providers need to be
educated about the appropriate use of proton pump inhibitors in patients with
gastroesophageal reflux disease and the role of diet and lifestyle modification
in this patient population.

Source: https://www.practiceupdate.com/c/69196/32/6/?elsca1=emc_conf_DDW2018During-1&elsca2=email&elsca3=practiceupdate_primary&elsca4=201852_DDW2018During-1&elsca5=conference&rid=Njk0NTYzMDM3MDcS1&lid=10332481