Journal article
Step-down management of gastroesophageal reflux disease
Gastroenterology (New York, N.Y. 1943), Vol.121(5), pp.1095-1100
11/2001
DOI: 10.1053/gast.2001.28649
PMID: 11677201
Abstract
Background & Aims: As the economic burden of gastroesophageal reflux disease (GERD) is largely weighted to maintenance as opposed to initial therapy, switching from more potent to less expensive medication once symptoms are alleviated (step-down therapy) may prove to be most cost-effective. This study aimed to prospectively evaluate the feasibility of step-down therapy in a cohort of patients with symptoms of uncomplicated GERD. Methods: Patients whose GERD symptoms were alleviated by proton pump inhibitors (PPIs) were recruited from outpatient general medicine clinics. After baseline demographic and quality of life information were obtained, PPIs were withdrawn from subjects in a stepwise fashion. Primary outcome was recurrence of symptoms during follow-up that required reinstitution of PPIs. Secondary outcomes included changes in quality of life and overall cost of management. Predictors of nonresponse to step-down were assessed. Results: Seventy-one of 73 enrolled subjects completed the study. Forty-one of 71 (58%) were asymptomatic off PPI therapy after 1 year of follow-up. Twenty-four of 71 (34%) required histamine 2-receptor antagonists, 5/71 (7%) prokinetic agents, 1/71 (1%) both, and 11/71 (15%) remained asymptomatic without medication. Quality of life did not significantly change, whereas management costs decreased by 37%. Multivariable analysis revealed younger age and a dominant symptom of heartburn to predict PPI requirement. Conclusions: Step-down therapy is successful in the majority of patients and can decrease costs without adversely affecting quality of life.
GASTOENTEROLOGY 2001;121:1095-1100
Details
- Title: Subtitle
- Step-down management of gastroesophageal reflux disease
- Creators
- John M Inadomi - Veterans Administration Center for Practice Management and Outcomes Research, Ann Arbor, MichiganRoula Jamal - VA Albuquerque Medical Center, Albuquerque, New MexicoGlen H Murata - VA Albuquerque Medical Center, Albuquerque, New MexicoRichard M Hoffman - VA Albuquerque Medical Center, Albuquerque, New MexicoLaurence A Lavezo - VA Albuquerque Medical Center, Albuquerque, New MexicoJustina M Vigil - VA Albuquerque Medical Center, Albuquerque, New MexicoKathleen M Swanson - VA Albuquerque Medical Center, Albuquerque, New MexicoAmnon Sonnenberg - VA Albuquerque Medical Center, Albuquerque, New Mexico
- Resource Type
- Journal article
- Publication Details
- Gastroenterology (New York, N.Y. 1943), Vol.121(5), pp.1095-1100
- DOI
- 10.1053/gast.2001.28649
- PMID
- 11677201
- NLM abbreviation
- Gastroenterology
- ISSN
- 0016-5085
- eISSN
- 1528-0012
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 11/2001
- Academic Unit
- Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094754102771
Metrics
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