Prescribing for GORD
There has been a rapid increase in PPI prescribing in recent years, and controlling the cost and improving the quality of prescribing is an issue of concern. Hence, the National Prescribing Service (NPS) conducted a clinical audit of prescribing of proton pump inhibitors (PPIs). The audit is recognised for the Quality Prescribing Initiative of the Practice Incentives Program for the year 1 May 2009 to 30 April 2010.
In earlier advice, the NPS recommends a step-down approach and test-and-treat approach for proton pump inhibitors, specifically esomeprazole, omeprazole and single enantiomer drugs used for treatment of gastro-oesophageal reflux disease and oesophagitis.
This step-down approach involves an initial 4-8 week course of standard-dose PPI, which rapidly controls symptoms and heals oesophagitis. Treatment can then be stepped down to the minimum dose that maintains symptom control. The NPS recommends that people known to have severe or complicated oesophagitis continue with daily PPIs. The step-down approach provides an opportunity to review the management of patients using PPIs, identify and implement a step-down strategy for suitable patients and review the concurrent use of drugs that may induce or exacerbate dyspepsia/ulceration.
The test-and-treat option is preferable in populations with a moderate to high prevalence of H. pylori infection (≥10%); empirical PPI is an initial option in low prevalence situations. The management of functional dyspepsia is challenging when initial antisecretory therapy and H. pylori eradication fails.
The Gastroenterology Society of Australia advises that most GORD patients require long-term management.4
Practice guidelines for the diagnosis and treatment of gastroesophageal reflux disease have been issued by the American Society of Gastroenterologists at www.tinyurl.com/28xt3jv and for oesophageal reflux testing at www.tinyurl.com/2bwxado
National Prescribing Service: www.nps.org.au, phone (02) 8217 8700
Gastroenterological Society of Australia: www.gesa.org.au, phone 1300 766 176
The Gut Foundation: www.gutfoundation.com, www.gut.nsw.edu.au, phone 9382 2749
American College of Gastroenterology: www.gi.org