Step-down from multiple- to single-dose proton pump inhibitors (PPIs): a prospective study of patients with heartburn or acid regurgitation completely relieved with PPIs
dc.contributor.author | Inadomi, John M. | en_US |
dc.contributor.author | McIntyre, Lisa | en_US |
dc.contributor.author | Bernard, Latoya | en_US |
dc.contributor.author | Fendrick, A. Mark | en_US |
dc.date.accessioned | 2010-06-01T19:31:59Z | |
dc.date.available | 2010-06-01T19:31:59Z | |
dc.date.issued | 2003-09 | en_US |
dc.identifier.citation | Inadomi, John M.; McIntyre, Lisa; Bernard, Latoya; Fendrick, A. Mark (2003). "Step-down from multiple- to single-dose proton pump inhibitors (PPIs): a prospective study of patients with heartburn or acid regurgitation completely relieved with PPIs." The American Journal of Gastroenterology 98(9): 1940-1944. <http://hdl.handle.net/2027.42/72670> | en_US |
dc.identifier.issn | 0002-9270 | en_US |
dc.identifier.issn | 1572-0241 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/72670 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=14499769&dopt=citation | en_US |
dc.description.abstract | Management costs for gastroesophageal reflux disease are high because of the expensive medications used for maintenance therapy. Previous studies have illustrated the success of step-down from proton pump inhibitors (PPIs) to less-expensive therapy once symptoms have abated. This study was conducted to determine whether patients requiring greater than single-dose PPI for initial symptom resolution could be stepped-down to single-dose PPI and whether this intervention decreased costs or adversely affected quality of life. Methods Consecutive patients in whom greater than single-dose PPI had completely alleviated reflux-type symptoms (heartburn or acid regurgitation) were recruited through the use of pharmacy records of PPI prescriptions. Eligible subjects completed baseline demographic information and quality-of-life surveys and were stepped-down to single-dose PPI (lansoprazole 30 mg or omeprazole 20 mg daily). Follow-up continued for 6 months or until subjects reported recurrence of reflux-type symptoms, at which point PPIs were reinstituted at the dose that had originally alleviated the subjects' symptoms. The primary outcome was the proportion of subjects in whom step-down was successful, defined as no recurrence of reflux-type symptoms on single-dose PPI. Results A total of 117 subjects enrolled in the study; all were followed to the primary endpoint. 79.5% did not report recurrent symptoms of heartburn or acid regurgitation during the 6 months after step-down to single-dose PPI. Logistic regression revealed that longer duration of PPI use before study enrollment was associated with greater likelihood of symptom recurrence with step-down. Although quality of life was not significantly altered, dyspepsia (excluding reflux-type symptoms) increased. Overall costs of management were reduced. Conclusion The majority of patients rendered asymptomatic on greater than single-dose PPI might be subsequently stepped-down to single-dose therapy without recurrence of reflux-type symptoms. This intervention can decrease management costs without adversely affecting quality of life. | en_US |
dc.format.extent | 55626 bytes | |
dc.format.extent | 3109 bytes | |
dc.format.mimetype | application/pdf | |
dc.format.mimetype | text/plain | |
dc.publisher | Blackwell Science Inc | en_US |
dc.rights | 2003 by Am. Coll. of Gastroenterology | en_US |
dc.title | Step-down from multiple- to single-dose proton pump inhibitors (PPIs): a prospective study of patients with heartburn or acid regurgitation completely relieved with PPIs | en_US |
dc.type | Article | en_US |
dc.subject.hlbsecondlevel | Internal Medicine and Specialties | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | Department of Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, Michigan, USA | en_US |
dc.contributor.affiliationum | Division of Gastroenterology, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA | en_US |
dc.contributor.affiliationum | Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies, University of Michigan School of Medicine, Ann Arbor, Michigan, USA | en_US |
dc.identifier.pmid | 14499769 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/72670/1/j.1572-0241.2003.07665.x.pdf | |
dc.identifier.doi | 10.1111/j.1572-0241.2003.07665.x | en_US |
dc.identifier.source | The American Journal of Gastroenterology | en_US |
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dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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