PMID- 32051298
OWN - NLM
STAT- MEDLINE
DCOM- 20210217
LR  - 20210217
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 10
IP  - 2
DP  - 2020 Feb 12
TI  - Is administration of proton pump inhibitors in functional dyspepsia worth the 
      risk of developing gastric cancer: a Markov model to bridge the gap between 
      scientific evidence and clinical practice.
PG  - e031091
LID - 10.1136/bmjopen-2019-031091 [doi]
LID - e031091
AB  - OBJECTIVE: To formulate a decision analysis model based on recently published 
      data that addresses the dilemma, whether improvement in quality of life 
      rationalises continued proton pump inhibitors (PPI) use despite the risk of 
      gastric cancer (GC) in patients with functional dyspepsia (FD). DESIGN: A Markov 
      model consisting of an initial decision regarding treatment with PPI (denoting it 
      by PPI strategy) or any other treatment without PPI (denoting it by placebo 
      strategy) was designed. DATA SOURCES: Data from prospective cross-sectional 
      studies indicating risk stratification for GC after the use of PPI, combined with 
      a Markov model that comprised the following states: Live, GC stages 1-4, Death. 
      OUTCOME MEASURES: The primary outputs included quality-adjusted life years 
      (QALYs) and life expectancy (LE). The improvement in utility in FD without PPI as 
      compared with PPI use was tested (PPI vs placebo strategies). Sensitivity 
      analyses were performed to evaluate the robustness of the model and address 
      uncertainty in the estimation of model parameters. SETTING: We considered only 
      patients whose symptoms were relieved with PPIs and thus, had a better quality of 
      life compared with patients who did not receive PPIs. RESULTS: The base case 
      model showed that PPIs compared with placebo decreased LE by 58.4 days with a 
      gain of 2.1 QALY. If utility (quality of life of patients with FD using PPI 
      compared with patients with FD without PPI) improved by more than 0.8%, PPI use 
      is considered better than placebo. Older patients benefited less from PPI 
      treatment than did younger patients. CONCLUSION: To bridge the gap between 
      evidence and decision making, we found that even a small improvement in the QALY 
      justified continuing PPI treatment.
CI  - (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Broide, Efrat
AU  - Broide E
AD  - The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir 
      Medical Center (Assaf Harofeh Medical), Zerifin, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Eindor-Abarbanel, Adi
AU  - Eindor-Abarbanel A
AUID- ORCID: 0000-0001-9677-0453
AD  - The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir 
      Medical Center (Assaf Harofeh Medical), Zerifin, Israel adiabarbanel@gmail.com.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Shirin, Haim
AU  - Shirin H
AD  - The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir 
      Medical Center (Assaf Harofeh Medical), Zerifin, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Richter, Vered
AU  - Richter V
AD  - The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir 
      Medical Center (Assaf Harofeh Medical), Zerifin, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Matalon, Shay
AU  - Matalon S
AD  - The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir 
      Medical Center (Assaf Harofeh Medical), Zerifin, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Leshno, Moshe
AU  - Leshno M
AD  - Coller School of Management, Tel Aviv University, Tel Aviv, Israel.
LA  - eng
PT  - Journal Article
DEP - 20200212
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Cross-Sectional Studies
MH  - Dyspepsia/*drug therapy
MH  - Humans
MH  - *Markov Chains
MH  - Prospective Studies
MH  - Proton Pump Inhibitors/administration & dosage/*adverse effects/therapeutic use
MH  - Risk Assessment
MH  - Stomach Neoplasms/*chemically induced
PMC - PMC7045183
OTO - NOTNLM
OT  - functional bowel disorders
OT  - gastroduodenal disease
OT  - gastroenterology
COIS- Competing interests: None declared.
EDAT- 2020/02/14 06:00
MHDA- 2021/02/18 06:00
PMCR- 2020/02/12
CRDT- 2020/02/14 06:00
PHST- 2020/02/14 06:00 [entrez]
PHST- 2020/02/14 06:00 [pubmed]
PHST- 2021/02/18 06:00 [medline]
PHST- 2020/02/12 00:00 [pmc-release]
AID - bmjopen-2019-031091 [pii]
AID - 10.1136/bmjopen-2019-031091 [doi]
PST - epublish
SO  - BMJ Open. 2020 Feb 12;10(2):e031091. doi: 10.1136/bmjopen-2019-031091.