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Collaboration between gastroenterologists and pharmacists improves the management of patients with chronic acid-related symptoms

At least 25 percent of the population suffers at some point from an acid-related disorder, such as gastro esophageal reflux disease (GERD), peptic ulcer disease, and dyspepsia (indigestion). There is little guidance for physicians in managing patients who have taken acid-suppressing medication such as proton pump inhibitors (PPIs) or histamine-2 blockers (H2Bs) for many years.

Chronic acid-suppressing medication use and long-term lifestyle changes may be reasonable for patients with GERD. However, patients without GERD who have upper gastrointestinal symptoms requiring the use of chronic acid suppressing prescription medications should have their blood tested for Helicobacter pylori (H. pylori) infection and undergo treatment if they test positive.

Educational outreach by gastroenterologists (academic detailing) and pharmacist reinforcement can improve management of patients without GERD who suffer from chronic acid-related symptoms. That's the conclusion of a study supported in part by the Agency for Healthcare Research and Quality (HS10391).

Researchers compared H. pylori testing and treatment and use of PPIs and H2Bs in three groups: usual care, low-intensity care (care guidelines and toolkits containing H. pylori testing and treatment information), and high-intensity care (care guidelines and toolkits plus academic group detailing by a gastroenterologist with reinforcement of care guidelines by pharmacists). High-intensity care increased H. pylori test ordering (29 percent) compared with usual care (9 percent) at 12 months. High-intensity care decreased PPI use by 9 percent per year but did not alter H2B use. The low-intensity intervention was ineffective.

See "Controlled trial of interventions to increase testing and treatment for Helicobacter pylori and reduce medication use in patients with chronic acid-related symptoms," by Sumit R. Majumdar, M.D., M.P.H., D. Ross-Degnan, Sc.D., Francis A. Farrayes, M.D., and others, in the April 2005 Alimentary Pharmacology & Therapeutics 21, pp. 1029-1039.

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