US veterans with chronic heartburn are often prescribed
higher-than-recommended doses of medicines to control the condition and many are
kept on the drugs far too long, according to a new study.
Researchers looked at 1 600 veterans who were diagnosed with chronic
heartburn - also known as gastroesophageal reflux disease (Gord) - and
prescribed a type of drug called a "proton pump inhibitor," such as Prilosec
GERD arises when the ring of muscle between the oesophaguses and stomach
fails to close properly, allowing stomach acids to splash up into the
oesophaguses. The main symptom is chronic heartburn.
These drugs - which also include Prevacid (lansoprazole) and Nexium
(esomeprazole) - are among the most widely used drugs in the United States and
provide relief for many patients with chronic heartburn. However, proper
prescribing is required to avoid prolonged and unnecessary use, according to
study first author Dr Andrew Gawron, a fellow in the gastroenterology division
and the Center for Healthcare Studies at Northwestern University Feinberg School
of Medicine, in Chicago.
What the study found
He and his colleagues found that most of the veterans in the study received
more than a three-month initial supply of proton pump inhibitor medication and
that nearly one-quarter of them were given high doses.
Only a few of the patients who were started on a high dose of this kind of
medication had reductions in dosing more than two years after their initial
prescription, according to the study published.
The researchers noted that it is recommended that proton pump inhibitors be
prescribed at the lowest effective dose for the first four to eight weeks. If
symptoms persist after eight weeks, doctors should try to find other potential
causes of symptoms and different types of treatment.
"We should always have a reevaluation after an initial prescription and ask,
'Does this patient need to be on this medication?'" Gawron said in a university
However, he said this study shows that "once these veterans are prescribed a
[proton pump inhibitor], they are rarely taken off of it. Two years after their
initial prescription, most are still on the drug."
The US National Institute of Diabetes and Digestive and Kidney Diseases has
more about GERD.
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