Chronic acid-related disorders are common and underinvestigated.
OBJECTIVE
The aims of this study were as follows: to establish the prevalence of chronic acid-related disorders in a managed care population; to describe these patients; and to examine rates of adherence to current guidelines for investigation of dyspepsia and peptic ulcer disease.


METHODS
The design was a population-based cohort study. The sample was drawn from 216,720 adult (aged >18 yr) members of a managed care organization that had an electronic medical record linked to administrative and pharmacy databases. We included adults with continuous enrollment from July, 1998, to January, 2000, who were dispensed histamine-2 blockers or proton-pump inhibitors, or both, for > or =1 yr. Dispensing data, sociodemographic and clinical information, comorbidities, and investigations were collected and analyzed.


RESULTS
The final cohort consisted of 5064 patients; 64% were aged > or =50 yr, 47% were male, and 11% were African American. The prevalence of chronic acid-related disorders was 2.3%. Gastroesophageal reflux disease (59%) was the most common condition, followed by dyspepsia (35% of cohort; 18% investigated by endoscopy). There were 917 dyspepsia patients > or =50 yr who had not been investigated by endoscopy (81% of dyspepsia patients in this age group). There were 97 patients with peptic ulcer disease who did not have a documented test for Helicobacter pylori (34% of patients with peptic ulcer disease).


CONCLUSIONS
Chronic acid-related disorders are common in primary care, and many patients use acid suppressing medications on a long-term basis. Nevertheless, according to current practice guidelines, our patients were underinvestigated. Future guidelines should specifically address the management of patients who use acid suppressing medications on a chronic basis.
Majumdar
Sumit R
SR
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
Soumerai
Stephen B
SB
Farraye
Francis A
FA
Lee
Marianne
M
Kemp
James A
JA
Henning
James M
JM
Schrammel
Peggy
P
LeCates
Robert F
RF
Ross-Degnan
Dennis
D
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use; D002908:Chronic Disease; D015331:Cohort Studies; D004415:Dyspepsia / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D005260:Female; D005744:Gastric Acid / Q000378:metabolism; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D010437:Peptic Ulcer / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D011336:Probability; D011379:Prognosis; D012720:Severity of Illness Index; D017678:Sex Distribution
D000897:Anti-Ulcer Agents