Objective: To investigate the magnitude of long-term prescription of acid secretion suppressant therapy in general practice, the frequency and methods of objectivation of the primary working diagnosis and the clinical grounds for the first prescription.
Design: Retrospective.
Method: Patients on long-term acid suppressant therapy were identified in a population of 46,813 patients in 24 general practices in the Amsterdam region by extraction from computerized medication databases of the pharmacists. The indications for the prescription and the investigations performed to confirm the working diagnosis were extracted from the patients' files in the GP practices. Long-term acid suppressant therapy was defined as prescription for at least 12 weeks in the period September 1994-August 1995.
Results: 922/46,813 patients (2%) were on long-term acid suppressant therapy. Mean duration of prescription was 33 weeks. The duration of prescription varied from 12 weeks in 8% of the patients to > 52 weeks in 23%. In 25% of the patients no objectivating investigations were performed, in 75% endoscopy or radiology was done; the predominant diagnoses were ulcerative disease (39%) and/or gastroesophageal reflux disease (49%) and functional dyspepsia (gastritis, or normal aspect) (18%). The Helicobacter pylori status had been established in 29% of the patients with ulcerative disease. Eradication therapy was reported in 44% of these patients.
Conclusion: Long-term acid suppressant therapy is frequently administered without a confirmed working diagnosis. An important part of the patients need H. pylori diagnostics, H. pylori eradication therapy and if possible tapering off of their medication.