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Systematic review : patterns of proton pump inhibitor use and adherence in gastroesophageal reflux disease.

Hungin, A.P. and Hill, C. and Molloy-Bland, M. and Raghunath, A. (2012) 'Systematic review : patterns of proton pump inhibitor use and adherence in gastroesophageal reflux disease.', Clinical gastroenterology and hepatology., 10 (2). pp. 109-116.


Background & Aims Variation in how proton pump inhibitors (PPIs) are taken likely influences their clinical effectiveness, and must be considered when estimating PPI failure rates. This review aimed to systematically investigate the literature on patterns of PPI use in patients with gastroesophageal reflux disease (GERD). METHODS PubMed and Embase were searched (1989–May 2010) to identify observational studies providing information on patterns of PPI use in patients with GERD. Results Of 902 studies identified, 13 met prespecified selection criteria. Across 2 database studies, 53.8%–67.7% of patients with GERD had a medication possession ratio (MPR) of >0.80. Across 2 more database studies, the mean MPR for the study population was 0.68 to 0.84. Across 3 surveys, 70%–84% of patients reported daily PPI use. In 2 surveys, the presence and severity of reflux symptoms increased PPI adherence, as did Barrett's esophagus in another 2 studies. Across 3 surveys, 11%–22.2% of patients reported twice daily PPI use, and across 6 studies 11.0%–44.8% of patients took GERD medication in addition to a PPI. Conclusions The results of this systematic review suggest that the majority of patients with GERD are relatively adherent to their PPI, although substantially different estimates were obtained using MPR data compared with surveys. Severe symptoms and the presence of Barrett's esophagus may increase PPI adherence, and other GERD medication is frequently taken in addition to a PPI. Limitations of studies in this area include inferring adherence from indirect MPR data, and recall bias associated with patient surveys.

Item Type:Article
Keywords:Medication Possession Ratio, Dosing Frequency, Concomitant Medication, Reflux Symptoms, Adherence.
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Record Created:10 Jan 2012 12:20
Last Modified:24 Feb 2012 15:07

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