Trends in gastroesophageal reflux disease as measured by the National Ambulatory Medical Care Survey.
BACKGROUND
The prevalence of reflux disease is increasing. Health-care utilization including physician visits for this disorder is lacking. Our purpose was to analyze the trend in physician visits for GERD from the period 1995-2006 using the National Ambulatory Medical Care Survey. We also sought to determine health-care utilization for GERD indirectly by assessing prescription trends for proton-pump inhibitors and H2 receptor blockers during the period.


METHODS
The National Ambulatory Medical Care Survey is a survey of approximately 3,000 office-based physicians that uses a three-stage probability sampling procedure to allow extrapolation to the US population. All visits between 1995 and 2006 for symptoms and/or diagnoses compatible with GERD were combined into a single categorical variable. Weighted data was utilized for descriptive and inferential statistical analysis.


RESULTS
After weighting, there were N = 321,513 adult ambulatory care encounters for all diagnoses. Visits for reflux increased throughout the examined period. Using logistic regression, visits for reflux were associated with female gender, age over 40, and calcium channel blocker use. Proton-pump inhibitor use increased substantially during the study period while H2 blocker use declined. Family practitioners and internists saw the majority of reflux patients.


CONCLUSIONS
The frequency of ambulatory visits in the United States for gastroesophageal reflux disease increased significantly between 1995 and 2006. The use of PPI therapy is increasing even more substantially. Older age, female gender, and use of calcium channel blockers were associated with a higher frequency of GERD visits. Health-care utilization for this disorder is increasing perhaps due to our ever-increasing epidemic of obesity.
Friedenberg
Frank K
FK
Department of Medicine, Temple University Hospital, Philadelphia, PA, USA. frank.friedenberg@tuhs.temple.edu
Hanlon
Alexandra
A
Vanar
Vishwas
V
Nehemia
Dawit
D
Mekapati
Jyothi
J
Nelson
Deborah B
DB
Richter
Joel E
JE
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data* / Q000639:trends; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data* / Q000639:trends; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors