Beliefs about GI medications and adherence to pharmacotherapy in functional GI disorder outpatients.
OBJECTIVE
Pharmacotherapy is a mainstay in functional gastrointestinal (GI) disorder (FGID) management, but little is known about patient attitudes toward medication regimens. Understanding patient concerns and adherence to pharmacotherapy is particularly important for off-label medication use (e.g., antidepressants) in FGID.


METHODS
Consecutive tertiary GI outpatients completed the Beliefs About Medications questionnaire (BMQ). Subjects were categorized as FGID and structural GI disease (SGID) using clinician diagnoses and Rome criteria; GI-specific medications and doses were recorded, and adherence to medication regimens was determined by patient self-report. BMQ domains (overuse, harm, necessity, and concern) were compared between FGID and SGID, with an interest in how these beliefs affected medication adherence. Psychiatric measures (depression, anxiety, and somatization) were assessed to gauge their influence on medication beliefs.


RESULTS
A total of 536 subjects (mean age 54.7±0.7 years, range 22-100 years; n=406, 75.7% female) were enrolled over a 5.5-year interval: 341 (63.6%) with FGID (IBS, 64.8%; functional dyspepsia, 51.0%, ≥2 FGIDs, 38.7%) and 142 (26.5%) with SGID (IBD, 28.9%; GERD, 23.2%). PPIs (n=231, 47.8%), tricyclic antidepressants (TCAs) (n=167, 34.6%), and anxiolytics (n=122, 25.3%) were common medications prescribed. FGID and SGID were similar across all BMQ domains (P>0.05 for overuse, harm, necessity, and concern). SGID subjects had higher necessity-concern framework (NCF) scores compared with FGID subjects (P=0.043). FGID medication adherence correlated negatively with concerns about medication harm (r=-0.24, P<0.001) and overuse (r=-0.15, P=0.001), whereas higher NCF differences predicted medication compliance (P=0.006). Medication concern and overuse scores correlated with psychiatric comorbidity among FGID subjects (P<0.03 for each). FGID patients prescribed TCAs (n=142, 41.6%) expressed a greater medication necessity (17.4±0.4 vs. 16.2±0.4, P=0.024) and found their GI regimen to be more helpful (P=0.054). FGID subjects not on TCAs expressed a greater apprehension about medication overuse (10.7±0.3 vs. 9.7±0.2, P=0.002) on the BMQ.


CONCLUSIONS
FGID subjects report medication necessity and concern scores comparable to patients with SGID but have negative perceptions about medications, particularly in the presence of psychiatric comorbidity; these factors may affect treatment adherence and willingness to initiate neuromodulator regimens.
Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
Benjamin
B
Cassell
Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
C Prakash
CP
Gyawali
Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
Vladimir M
VM
Kushnir
Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.|Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA.
Britt M
BM
Gott
Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
Billy D
BD
Nix
Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.|Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA.|John Cochran VA Medical Center, St Louis, Missouri, USA.
Gregory S
GS
Sayuk
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D001294:Attitude to Health; D016022:Case-Control Studies; D003863:Depression / Q000523:psychology; D004415:Dyspepsia / Q000188:drug therapy / Q000523:psychology; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000523:psychology; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000523:psychology; D043183:Irritable Bowel Syndrome / Q000188:drug therapy / Q000523:psychology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D056687:Off-Label Use; D010045:Outpatients; D000067490:Prescription Drug Overuse; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013001:Somatoform Disorders / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors