Symptoms in patients on long-term proton pump inhibitors: prevalence and predictors.
BACKGROUND
Symptom control in primary care patients on long-term proton pump inhibitor (PPI) treatment is poorly understood.


OBJECTIVE
To explore associations between symptom control and demographics, lifestyle, PPI use, diagnosis and Helicobacter pylori status.


METHODS
A cross-sectional survey (n = 726) using note reviews, questionnaires and carbon-13 urea breath testing. Determinants of symptom control [Leeds Dyspepsia Questionnaire (LDQ), Carlsson and Dent Reflux Questionnaire (CDRQ), health-related quality-of-life measures (EuroQoL: EQ-5D and EQ-VAS)] were explored using stepwise linear regression.


RESULTS
Moderate or severe dyspepsia symptoms occurred in 61% of subjects (LDQ) and reflux symptoms in 59% (CDRQ). Age, gender, smoking and body mass index had little or no influence upon symptom control or PPI use. Average symptom scores and PPI use were lower in patients with non-ulcer dyspepsia and gastro-protection than gastro-oesophageal reflux disease (GERD) and uninvestigated dyspepsia. H. pylori infection was associated with lower reflux symptom scores only in patients with GERD and uninvestigated dyspepsia. EQ-5D was not able to discriminate between diagnostic groups, although the EQ-VAS performed well.


CONCLUSIONS
A majority of patients suffered ongoing moderate or severe symptoms. GERD and uninvestigated dyspepsia were associated with poorer long-term symptom control; H. pylori appeared to have a protective effect on reflux symptoms in these patients.
Raghunath
A S
AS
School of Medicine and Health, Durham University, Wolfson Research Institute, University Boulevard, Stockton-on-Tees, UK. raghu@nath.freeserve.co.uk
Hungin
A P S
AP
Mason
J
J
Jackson
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001944:Breath Tests; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004415:Dyspepsia / Q000188:drug therapy* / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires
D054328:Proton Pump Inhibitors