Early testing for acid reflux disease with pH monitoring studies, could save significant amounts of money according to a study presented at Digestive Diseases Week in Florida.
Researchers reported that almost a third of patients undergoing treatment for acid reflux have no measurable signs of the chronic condition, and they projected cost-savings of up to US$7,300 per patient over ten years if current diagnostic guidelines were changed.
In the USA, patients with suspected reflux disease are typically given a 2-month course of PPI’s (proton pump inhibitors) as per the American Gastroenterological Association Guidelines. However, patients very often stay on the drugs for much longer than this because their family doctor may be reluctant to refer them for 24-hour pH studies. This contributes to the staggering costs of PPI prescriptions worldwide – almost $10 billion each year.
Exactly the same pattern is seen in the UK, where reflux patients are put onto anti-reflux therapy (usually PPIs) and often remain on treatment for many years. Some of these patients have true reflux disease, but a significant proportion do not and continue taking prescription medication which may not be without side-effects.
The evidence clearly shows that GPs and other doctors who see possible reflux patients, need to have a much lower threshold with regard to referral for pH and other studies to confirm the diagnosis of GORD. As Dr David Kleiman, a research fellow from New York Presbyterian Hospital says “Many patients remain on proton-pump inhibitors for years after the trial period without any confirmation that they are being treated for the right diagnosis. Prompt pH monitoring could help clinicians to accurately diagnosis GERD, increase healthy outcomes for patients and save money.”
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Kleiman D et al. Early referral for 24-hour esophageal pH monitoring is more cost-effective than prolonged use of proton-pump inhibitors in patients with suspected gastro-oesophageal reflux disease. Digestive Disease Week 2013, Abstract 201