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Development of a refractory gastro‐oesophageal reflux score using an administrative claims database
Author(s) -
Gerson L. B.,
Bonafede M.,
Princic N.,
Gregory C.,
Farr A.,
Balu S.
Publication year - 2011
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2011.04755.x
Subject(s) - gerd , medicine , reflux , refractory (planetary science) , gastroenterology , proton pump inhibitor , disease , physics , astrobiology
Aliment Pharmacol Ther 2011; 34: 555–567 Summary 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.