Patient selection for therapy reduction after long-term daily proton pump inhibitor treatment for gastro-oesophageal reflux disease: trial and error.
BACKGROUND
Proton pump inhibitor (PPI) therapy reduction after long-term daily treatment for gastro-oesophageal reflux disease (GORD) symptomatology proves difficult in primary care practice. We aimed to identify patient and/or disease characteristics in long-term daily PPI users predicting a successful switch to less than daily therapy.


METHODS
GORD patients who after long-term continuous treatment were able to use less than a daily PPI dose in a placebo-controlled trial were compared to patients who persisted in a daily dosage with respect to general, lifestyle and quality of life characteristics (SF-36 Health Survey) as well as psychological factors (Symptom Check List 90), symptom control on daily PPI (Quality of Life in Reflux and Dyspepsia questionnaire), disease and medication history.


RESULTS
Adequate symptom control on daily PPI use and female gender were determinants of successful therapy reduction. A prediction rule including the Quality of Life in Reflux and Dyspepsia vitality dimension and gender correctly predicted 64% of patients to both less than daily and sustained daily treatment (area under the receiver operating characteristic curve = 0.69).


CONCLUSIONS
In the heterogeneous population of PPI users for GORD in primary care, no clinically useful, easily obtainable combination of patient characteristics was able to adequately predict eligibility for therapy reduction. Switching to less than daily therapy remains a process of trial and error in which motivation of the patient and support by the physician will be important factors for success.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. a.w.vandervelden@umcutrecht.nl
Alike W
AW
van der Velden
Niek J
NJ
de Wit
A Otto
AO
Quartero
Diederick E
DE
Grobbee
Mattijs E
ME
Numans
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D004415:Dyspepsia / Q000188:drug therapy*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy*; D006306:Health Surveys; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D018579:Patient Selection; D011320:Primary Health Care; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D000077402:Pantoprazole