Better Counseling May Help Deal With PPI Overuse

JULY 20, 2012
Jeannette Y. Wick, RPh, MBA, FASCP
Clinicians need to modify their approach when informing patients of negative reflux testing results, according to the authors of a new study.

Continuing to take medication beyond the point that it is useful or necessary is a serious concern among health care providers. Doing so has the potential to waste money and expose patients to unnecessary side effects and drug interactions. The results of a study published in the June 2012 edition of Clinical Gastroenterology and Hepatology indicates that this is a particular problem among patients being treated for gastroesophageal reflux disease (GERD).
In the study, researchers from Northwestern University’s Feinberg School of Medicine conducted phone interviews with 90 patients who had received negative results from pH testing an average of 25 months before the interviews. All participants had undergone either ambulatory pH testing using endoscopy or 48-hour Bravo pH monitoring between 2006 and 2010, and none had test-confirmed GERD. Nonetheless, the researchers found that 42% of the participants (38 patients) continued taking proton pump inhibitors (PPIs) even though the negative results of their diagnostic tests had been communicated to them.
Fewer than 20% of patients remembered being told to stop taking PPIs. Chart documentation did not help the researchers determine whether clinicians had reminded patients to stop their PPIs; only 15 of the patients’ medical records indicated that they had received counseling. However, more than half of the subjects who continued to take PPIs had positive scores on the GerdQ (a survey tool used to diagnose GERD), which suggests that they may have had GERD despite negative pH tests. Since up to 25% of PPI-treated patients have unresolved symptoms, better treatment plans are needed for these patients. They may suffer from non-acid reflux disease.
The authors suggest that clinicians should create systematic counseling methods for use when informing patients of negative reflux testing results, and find alternative diagnoses and treatments for patients whose symptoms are poorly relieved by PPIs.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.

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