Pediatric gastroesophageal reflux disease and acid-related conditions: trends in incidence of diagnosis and acid suppression therapy.
OBJECTIVE
To describe the incidence of diagnosis of gastroesophageal reflux disease and acid-related conditions (GERD/ARC) throughout childhood and characterize patterns of diagnosis and treatment with proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H(2)RAs).


METHODS
Cohorts of GERD/ARC children (age 0-18 years) were identified from a large US administrative claims database covering 1999-2005 using ICD-9 codes. Incidence, healthcare utilization (HCU), costs, therapy discontinuation and switching rates were compared between various age and patient groups.


RESULTS
Between 2000 and 2005 annual incidence of GERD/ARC diagnosis among infants (age ≤1 year) more than tripled (from 3.4 to 12.3%) and increased by 30% to 50% in other age groups. Patients diagnosed by GI specialists (9.2%) were more likely to be treated with PPIs compared to patients diagnosed by primary care physician (PCP). PPI-initiated patients doubled (from 31.5% in 1999 to 62.6% in 2005) and, when compared with H(2)RA-initiated patients, were associated with 30% less discontinuation and 90% less therapy switching in the first month, and with higher comorbidity burden and pre-treatment total HCU and costs when diagnosed by GI specialists.


CONCLUSIONS
The use of an exploratory definition for GERD/ARC, administrative claims data and potential coding errors in diagnosis codes used in selection process may limit the generalizability of the results.


CONCLUSIONS
GERD/ARC incidence increased for children of all ages between 2000 and 2005. PCPs made the majority of diagnoses. PPI initiations have now surpassed H(2)RA initiations.
Nelson
S P
SP
The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Kothari
S
S
Wu
E Q
EQ
Beaulieu
N
N
McHale
J M
JM
Dabbous
O H
OH
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D006635:Histamine H2 Antagonists / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007345:Insurance Claim Review; D016015:Logistic Models; D008297:Male; D054328:Proton Pump Inhibitors / Q000191:economics / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors