Prescribing habits in primary biliary cirrhosis: a national survey.
BACKGROUND
Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease of unknown aetiology. A number of drugs have been used in its treatment, but only ursodeoxycholic acid (UDCA) has been shown to improve survival. Our aims were to determine the current prescribing habits in PBC of all practising gastroenterologists in the UK.


METHODS
A postal questionnaire was sent to 454 gastroenterologists in 1996, followed by a second questionnaire a month later to the non-responders.


RESULTS
Of 454 doctors sent questionnaires, 379 (83%) replied. Of these, 58 were excluded from further analysis as they were not practising gastroenterologists. There are an estimated 4337 patients with PBC being seen by gastroenterologists in hospitals. Of these, only 1376 (32%) are being seen in liver units. Ninety-one per cent of gastroenterologists look after patients with PBC (median 10 patients, range 1-500). Ninety-five per cent of gastroenterologists prescribe UDCA but there is a large dose range (median 11.5 mg/kg/day, range 1.5-23.1). Of these, 93% also prescribe cholestyramine. Only 45 (14%) gastroenterologists prescribed other treatments for PBC (13 colchicine, 24 steroids, nine penicillamine, 13 immunosuppressants). Only 53 (17%) treat the symptoms/complications of PBC (37 fat-soluble vitamins, 15 calcium, six bisphosphonates, one hormone replacement therapy, 10 antihistamines, 10 rifampicin).


CONCLUSIONS
UDCA is being prescribed for PBC by the majority of practising gastroenterologists but over a wide dose range. Very few gastroenterologists are using preventive treatment for osteoporosis in this high-risk group. Other treatments, as yet unproven in trials, are being prescribed by a minority of gastroenterologists.
Verma
A
A
Division of Gastroenterology, Endocrinology and Metabolism, St George's Hospital Medical School, London, UK.
Jazrawi
R P
RP
Ahmed
H A
HA
Northfield
T C
TC
D002756:Cholagogues and Choleretics / Q000008:administration & dosage; D002792:Cholestyramine Resin / Q000008:administration & dosage; D019468:Disease Management; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005762:Gastroenterology / Q000379:methods; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000188:drug therapy*; D006113:United Kingdom; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage
D002756:Cholagogues and Choleretics; D002792:Cholestyramine Resin; D014580:Ursodeoxycholic Acid