Prescription of acid-suppressing drugs in relation to endoscopic diagnosis: a record-linkage study.
BACKGROUND
Although widely used, few data are available on the appropriateness of prescribing of acid-suppressing drugs (ASDs), despite guidelines on the investigation and treatment of dyspeptic patients.


METHODS
We created a database of 62 000 endoscopy examinations and record-linked these to a prescribing database. Endoscopic diagnoses were classified into peptic, nonpeptic and others. The H2-antagonists, omeprazole and misoprostol, were studied.


RESULTS
35 000 patients had one or more endoscopies during 1978-93; two-thirds were over 45 years of age at first endoscopy. A quarter of all patients who had been endoscoped had consistently normal examinations. Peptic oesophageal pathology was the commonest positive finding. A quarter of those prescribed ASDs between 1989 and 1993 had been endoscoped between 1978 and 1993. In those with a peptic diagnosis prescribed any ASD, the pathologies found were: oesophageal (42.9%), duodenal (36.3%) and gastro-pyloric (21.3%). Patients prescribed omeprazole were more likely to have undergone endoscopy than those prescribed other ASDs, and they were also more likely to have peptic oesophageal pathology. Long-term prescribing (>56 days per year) occurred in two-thirds of patients prescribed ASDs and 40% had at least one endoscopy. In those prescribed short-term ASDs, 20% had undergone at least one endoscopy. Peptic and nonpeptic endoscopic pathology was associated with increased ASD prescribing, but a normal endoscopy did not reduce prescribing.


CONCLUSIONS
ASD prescribing appeared to be mainly symptom-driven. Positive endoscopic findings increased the prescribing of ASDs, but normal findings did not reduce it.
Prach
A T
AT
Medicines Monitoring Unit, Department of Clinical Pharmacology, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK. andrzej@memo.dundee.ac.uk
McGilchrist
M M
MM
Murray
F E
FE
Johnston
D A
DA
MacDonald
T M
TM
D000368:Aged; D000863:Antacids / Q000627:therapeutic use*; D011307:Drug Prescriptions; D004363:Drug Utilization; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D010437:Peptic Ulcer / Q000188:drug therapy / Q000473:pathology
D000863:Antacids