Getting the Right Rx Dose to Treat GERD

GERD patients treated by gastroenterologists were more likely to take PPIs correctly

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Treating gastric reflux with over-the-counter (OTC) medication might not bring relief, even though the medications might be similar to the prescription brands.

Gastroesophageal reflux disease (GERD) occurs when the contents of the stomach leak back up into the esophagus, causing pain and heartburn.

Patients with GERD can see a specialist or their primary care doctor for treatment with medications called proton pump inhibitors (PPIs). Some brand names of PPIs are Prevacid, Prilosec and Nexium.

GERD patients can also purchase many of these medications over the counter to treat their symptoms, although the OTC medications may be available in different strengths than the prescription versions.

A recent study found that patients who received their GERD treatment from a gastroenterologist were more likely to take their medications correctly. They also tended to have less frequent and less severe GERD symptoms.

"See a gastroenterologist for your GERD symptoms."

This research was led by M. Michael Wolfe, MD, from the Division of Gastroenterology at the MetroHealth Medical Center at Case Western Reserve University in Cleveland, Ohio.

Unlike antacids, which can be taken anytime for excess stomach acid, PPIs must be taken before a meal, usually breakfast.

Dr. Wolfe and colleagues compared whether PPIs given by a gastroenterologist, primary care doctor or purchased over the counter made a difference in whether the medications were taken properly and whether the patients got relief from their symptoms.

The researchers surveyed 1,959 patients who were diagnosed with GERD. The surveys asked the patients how they treated their GERD and about GERD symptoms they experienced while being treated.

Men and women, ages 18 and older, were included in the study.

Of the 1,959 patients, 31 percent treated their GERD symptoms with PPIs.

A total of 37 percent of the patients who treated their GERD got a prescription from their primary care doctor, 31 percent from a gastroenterologist and 32 percent bought their PPIs over the counter.

Medication doses varied with source of the medications.

Considering proper timing and amount of medication taken, 39 percent of the patients who took OTC PPIs received the proper dose, and 47 percent of the patients who were treated by and received a prescription from their primary care doctor took the proper dose.

The results showed that 71 percent of the patients who were treated with a prescription from a gastroenterologist received the proper dose.

The frequency and severity of the GERD symptoms experienced by patients who took medications prescribed by a gastroenterologist were less than those of patients who were treated by their primary care doctor or those who took OTC PPIs.

Compared to those prescribed medications by a gastroenterologist or primary care doctor, more patients in the OTC group took lower doses than recommended.

More patients in the group taking medications prescribed by a primary care doctor took too much medication, compared to the OTC or gastroenterologist-treated patients.

The patients’ symptom relief corresponded to whether they received the proper dose. Patients who took more or less medication than recommended reported more frequent and worse symptoms than patients who took the correct dose.

Because antacids can be taken as needed, the authors noted that they were not surprised that people who bought OTC PPIs did not take them as required and so did not achieve relief of their symptoms.

“Optimal dosing would likely reduce morbidity [sickness] and healthcare costs while improving overall quality of life,” the authors wrote.

"Furthermore, package inserts need to more clearly emphasize the importance of daily prebreakfast PPI use to maximize acid suppression," they wrote.

Several limitations of this study were noted by the authors. Some OTC PPIs are sold at lower doses than the prescription medications some patients took. The researchers also noted that the survey used to score patient symptoms included some symptoms that were not specific to GERD.

This research was published in the June issue of The American Journal of Gastroenterology.

The authors declared no conflicts of interest.

Review Date: 
June 18, 2014
Last Updated:
June 20, 2014