title: Development of a refractory gastro-oesophageal reflux score using an administrative claims database.
abstract: BACKGROUND
  Approximately one-third of gastro-oesophageal reflux disease (GERD) patients demonstrate refractory symptoms following treatment with proton pump inhibitor (PPI) therapy.
  
  
  OBJECTIVE
  To develop a refractory GERD score that can be applied to predict patients' healthcare utilisation.
  
  
  METHODS
  We enrolled adults (≥18 years) with a diagnosis of GERD. Refractory GERD was evaluated on an 8-point scale where 1 point was given for each of the following criteria: doubling, addition, or switching of GERD medication dose, receipt of a GERD-related endoscopic procedure or surgery, or ≥3 GERD-related outpatient visits. Refractory GERD was defined as the presence of two or more points.
  
  
  RESULTS
  A total of 135,139 GERD patients (44% male) were analysed with a mean (±s.d.) age of 52.9 ± 15 years. The mean overall refractory GERD score was 1.12 ± 1.2 (range 0-8 on an 8-point scale); 31% of patients had refractory GERD with a mean score of 2.56 ± 0.82. Among patients with refractory GERD, 31% doubled their GERD medication, 28% added a new GERD medication, 60% switched GERD medications, 54% had a GERD-related procedure and 1% had a GERD-related surgery. Patients with refractory GERD were more likely to be female (59% vs. 55%, P < 0.001) and had a higher co-morbidity score (0.78 vs. 0.56, P < 0.001). The overall mean costs for refractory patients during the study period were significantly higher compared with treatment-responsive patients ($18,088 ± $36,220 vs. $11,044 ± $22,955, P < 0.001).
  
  
  CONCLUSIONS
  Refractory GERD was present in approximately one-third of the GERD patients. We created a GERD refractory score that could define need for increased anti-reflux therapy and predict higher healthcare resource utilisation.
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, CA, USA. lgersonmd@yahoo.com
authors.forename: L B
authors.initials: LB
authors.lastname: Gerson
authors.forename: M
authors.initials: M
authors.lastname: Bonafede
authors.forename: N
authors.initials: N
authors.lastname: Princic
authors.forename: C
authors.initials: C
authors.lastname: Gregory
authors.forename: A
authors.initials: A
authors.lastname: Farr
authors.forename: S
authors.initials: S
authors.lastname: Balu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D004351:Drug Resistance; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D017048:Health Care Costs; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors