Symptoms in patients on long-term proton pump inhibitors: prevalence and predictors

Aliment Pharmacol Ther. 2009 Feb 15;29(4):431-9. doi: 10.1111/j.1365-2036.2008.03897.x. Epub 2008 Nov 17.

Abstract

Background: Symptom control in primary care patients on long-term proton pump inhibitor (PPI) treatment is poorly understood.

Aim: To explore associations between symptom control and demographics, lifestyle, PPI use, diagnosis and Helicobacter pylori status.

Methods: A cross-sectional survey (n = 726) using note reviews, questionnaires and carbon-13 urea breath testing. Determinants of symptom control [Leeds Dyspepsia Questionnaire (LDQ), Carlsson and Dent Reflux Questionnaire (CDRQ), health-related quality-of-life measures (EuroQoL: EQ-5D and EQ-VAS)] were explored using stepwise linear regression.

Results: Moderate or severe dyspepsia symptoms occurred in 61% of subjects (LDQ) and reflux symptoms in 59% (CDRQ). Age, gender, smoking and body mass index had little or no influence upon symptom control or PPI use. Average symptom scores and PPI use were lower in patients with non-ulcer dyspepsia and gastro-protection than gastro-oesophageal reflux disease (GERD) and uninvestigated dyspepsia. H. pylori infection was associated with lower reflux symptom scores only in patients with GERD and uninvestigated dyspepsia. EQ-5D was not able to discriminate between diagnostic groups, although the EQ-VAS performed well.

Conclusions: A majority of patients suffered ongoing moderate or severe symptoms. GERD and uninvestigated dyspepsia were associated with poorer long-term symptom control; H. pylori appeared to have a protective effect on reflux symptoms in these patients.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breath Tests
  • Cross-Sectional Studies
  • Dose-Response Relationship, Drug
  • Dyspepsia / drug therapy*
  • Dyspepsia / epidemiology
  • England / epidemiology
  • Female
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / drug therapy*
  • Gastroesophageal Reflux / epidemiology
  • Helicobacter Infections / complications
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / epidemiology
  • Helicobacter pylori
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Proton Pump Inhibitors / adverse effects*
  • Quality of Life / psychology
  • Surveys and Questionnaires

Substances

  • Proton Pump Inhibitors