PMID- 21714794
OWN - NLM
STAT- MEDLINE
DCOM- 20111223
LR  - 20110802
IS  - 1365-2036 (Electronic)
IS  - 0269-2813 (Linking)
VI  - 34
IP  - 5
DP  - 2011 Sep
TI  - Development of a refractory gastro-oesophageal reflux score using an 
      administrative claims database.
PG  - 555-67
LID - 10.1111/j.1365-2036.2011.04755.x [doi]
AB  - 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.
CI  - (c) 2011 Blackwell Publishing Ltd.
FAU - Gerson, L B
AU  - Gerson LB
AD  - Division of Gastroenterology and Hepatology, Stanford University School of 
      Medicine, CA, USA. lgersonmd@yahoo.com
FAU - Bonafede, M
AU  - Bonafede M
FAU - Princic, N
AU  - Princic N
FAU - Gregory, C
AU  - Gregory C
FAU - Farr, A
AU  - Farr A
FAU - Balu, S
AU  - Balu S
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110630
PL  - England
TA  - Aliment Pharmacol Ther
JT  - Alimentary pharmacology & therapeutics
JID - 8707234
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Databases, Factual
MH  - Drug Resistance
MH  - Female
MH  - Gastroesophageal Reflux/*drug therapy/economics/physiopathology
MH  - Health Care Costs
MH  - Humans
MH  - Male
MH  - Medicare
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Predictive Value of Tests
MH  - Proton Pump Inhibitors/economics/*therapeutic use
MH  - Retrospective Studies
MH  - *Severity of Illness Index
MH  - Treatment Outcome
MH  - United States
MH  - Young Adult
EDAT- 2011/07/01 06:00
MHDA- 2011/12/24 06:00
CRDT- 2011/07/01 06:00
PHST- 2011/07/01 06:00 [entrez]
PHST- 2011/07/01 06:00 [pubmed]
PHST- 2011/12/24 06:00 [medline]
AID - 10.1111/j.1365-2036.2011.04755.x [doi]
PST - ppublish
SO  - Aliment Pharmacol Ther. 2011 Sep;34(5):555-67. doi: 
      10.1111/j.1365-2036.2011.04755.x. Epub 2011 Jun 30.