title: Gastroesophageal reflux disease in primary care: using changes in proton pump inhibitor therapy as an indicator of partial response.
abstract: OBJECTIVE
  Up to one-third of patients with gastroesophageal reflux disease (GERD) in primary care have residual symptoms despite proton pump inhibitor (PPI) therapy. We aimed to characterize partial response to PPIs among adult patients in UK primary care.
  
  
  METHODS
  Newly diagnosed GERD patients aged 20-79 years who were prescribed PPI for treatment of GERD were identified in The Health Improvement Network. Those with a treatment change suggesting partial response to PPIs (new treatment added to PPI, increased PPI dose, or switching PPI) during the subsequent 6 months were identified as potential cases and confirmed after manual review of each patient's complete computer medical record including free-text comments. Patients without these treatment changes were study controls. A nested case-control analysis was conducted using logistic regression.
  
  
  RESULTS
  The proportion of newly diagnosed GERD patients with partial response to PPI therapy was 18.6% (1201/6453). Partial response was associated with female gender (odds ratio [OR]: 1.20; 95% confidence interval [CI]: 1.05-1.37), anxiety or depression (OR: 1.15; 95% CI: 1.00-1.31), and prescription of ≥ 6 drugs in the month before GERD diagnosis (OR: 1.42; 95% CI: 1.14-1.78). Among new PPI users (n = 2907), partial response was associated with esophageal ulcer or Barrett's esophagus at initial diagnosis (OR: 3.14; 95% CI: 1.60-6.17).
  
  
  CONCLUSIONS
  Approximately one in five newly diagnosed patients with GERD appear to have a partial response to PPI therapy. Female gender, polymedication, and a severe initial diagnosis may be associated with partial response.
authors.affiliation: Spanish Centre for Pharmacoepidemiologic Research-CEIFE, Madrid, Spain. aruigomez@ceife.es
authors.forename: Ana
authors.initials: A
authors.lastname: Ruigómez
authors.forename: Saga
authors.initials: S
authors.lastname: Johansson
authors.forename: Börje
authors.initials: B
authors.lastname: Wernersson
authors.forename: Oscar
authors.initials: O
authors.lastname: Fernández Cantero
authors.forename: Luis A
authors.initials: LA
authors.lastname: García Rodríguez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000209:etiology; D016022:Case-Control Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003863:Depression / Q000453:epidemiology; D011307:Drug Prescriptions; D057286:Electronic Health Records; D004942:Esophagitis, Peptic / Q000188:drug therapy* / Q000209:etiology; D004947:Esophagus; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011320:Primary Health Care; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012737:Sex Factors; D016896:Treatment Outcome; D014456:Ulcer / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors