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Development of a refractory gastro-oesophageal reflux score using an administrative claims database.
MedLine Citation:
PMID:  21714794     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background  Approximately one-third of gastro-oesophageal reflux disease (GERD) patients demonstrate refractory symptoms following treatment with proton pump inhibitor (PPI) therapy. Aim  To develop a refractory GERD score that can be applied to predict patients' healthcare utilisation. Methods  We enrolled adults (≥18 years) with a diagnosis of GERD. Refractory GERD was evaluated on an 8-point scale where 1 point was given for each of the following criteria: doubling, addition, or switching of GERD medication dose, receipt of a GERD-related endoscopic procedure or surgery, or ≥3 GERD-related outpatient visits. Refractory GERD was defined as the presence of two or more points. Results  A total of 135 139 GERD patients (44% male) were analysed with a mean (±s.d.) age of 52.9 ± 15 years. The mean overall refractory GERD score was 1.12 ± 1.2 (range 0-8 on an 8-point scale); 31% of patients had refractory GERD with a mean score of 2.56 ± 0.82. Among patients with refractory GERD, 31% doubled their GERD medication, 28% added a new GERD medication, 60% switched GERD medications, 54% had a GERD-related procedure and 1% had a GERD-related surgery. Patients with refractory GERD were more likely to be female (59% vs. 55%, P < 0.001) and had a higher co-morbidity score (0.78 vs. 0.56, P < 0.001). The overall mean costs for refractory patients during the study period were significantly higher compared with treatment-responsive patients ($18 088 ± $36 220 vs. $11 044 ± $22 955, P < 0.001). Conclusions  Refractory GERD was present in approximately one-third of the GERD patients. We created a GERD refractory score that could define need for increased anti-reflux therapy and predict higher healthcare resource utilisation.
Authors:
L B Gerson; M Bonafede; N Princic; C Gregory; A Farr; S Balu
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-30
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  -     ISSN:  1365-2036     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Blackwell Publishing Ltd.
Affiliation:
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA. Thomson Reuters, Cambridge, MA, USA. Eisai, Inc., Woodcliff Lake, NJ, USA.
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