Expert Opinion on the Prescription Practice of Proton Pump Inhibitors in Indian Settings for Managing Gastro-Esophageal Reflux Diseases

Manjula S *

Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.

Krishna Kumar M

Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.

*Author to whom correspondence should be addressed.


Abstract

Background: Although proton pump inhibitors (PPIs) were widely prescribed, the perspectives of clinicians regarding PPIs in the management of gastro-esophageal reflux diseases (GERD) was lacking. So, this study intended to gather clinicians' opinion regarding the prescription practice of PPIs and other GERD-related experiences for managing gastroesophageal reflux disease in routine Indian settings.

Methods: This cross-sectional study gathered expert opinion of specialists using a 21-item, multiple-response questionnaire. The survey included questions pertaining to current prescription trends, clinical observations, and preferences related to the use of PPIs, and GERD-related experiences. Descriptive statistics were carried out for data analysis.

Results: The survey involved 205 clinicians, with the majority (49.76%) indicating the use of American College of Gastroenterology (ACG) guidelines for managing GERD in routine practice. Approximately 68% of the clinicians emphasized the symptoms of heartburn and/or regurgitation as the most important for diagnosing GERD. According to 53% of the clinicians, the most common symptom reported by GERD patients was heartburn. Proton pump inhibitors (PPIs) were favored by the majority of clinicians (87.32%) as the first-line treatment for GERD. Among PPIs, approximately 90% preferred pantoprazole due to its faster onset of action. Additionally, nearly 91% reported using domperidone as the preferred gastroprokinetic in combination with PPI therapy. About 57% of clinicians preferred pellets/capsules for PPI administration. Majority (85.37%) preferred pantoprazole as adjuvant therapy and most of them (98.54) reported no key side effects with PPI use.

Conclusion: The findings underscored the clinical utility of ACG guidelines for the effective management of GERD. PPIs were favored by the majority of clinicians as the first-line treatment for GERD, with pantoprazole emerging as the preferred choice due to its faster onset of action.

Keywords: Proton pump inhibitors, gastro-esophageal reflux disease, heartburn, pantoprazole, domperidone


How to Cite

Manjula S, and Krishna Kumar M. 2024. “Expert Opinion on the Prescription Practice of Proton Pump Inhibitors in Indian Settings for Managing Gastro-Esophageal Reflux Diseases”. Asian Journal of Research and Reports in Gastroenterology 7 (1):96-103. https://journalajrrga.com/index.php/AJRRGA/article/view/137.


References

Sweis R, Fox M. The global burden of gastro-oesophageal reflux disease: more than just heartburn and regurgitation. The Lancet Gastroenterology & Hepatology. 2020 Jun 1;5(6):519–21.

El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014 Jun;63(6): 871–80.

Sharma PK, Ahuja V, Madan K, Gupta S, Raizada A, Sharma MP. Prevalence, severity, and risk factors of symptomatic gastroesophageal reflux disease among employees of a large hospital in northern India. Indian J Gastroenterol. 2011 May; 30(3):128–34.

Ahmed A, Clarke JO. Proton Pump Inhibitors (PPI). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 May 6].

Shin JM, Sachs G. Pharmacology of Proton Pump Inhibitors. Curr Gastroenterol Rep. 2008 Dec;10(6):528–34.

Shanika LGT, Reynolds A, Pattison S, Braund R. Proton pump inhibitor use: systematic review of global trends and practices. Eur J Clin Pharmacol. 2023 Sep 1;79(9):1159–72.

Histamine Type-2 Receptor Antagonists (H2 Blockers). In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012 [cited 2024 May 6].

Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022 Jan 1;117(1):27–56.

Naguib R, Alfawaz AS, Alqahtani AM, Balkhasl KM, Alnafee RA, Naji SN. Awareness, experience, and practice of physicians regarding adult gastroesophageal reflux disease (GERD) in Riyadh, Saudi Arabia. J Family Med Prim Care. 2020 Aug 25;9(8):4181–9.

Hojo M, Nagahara A, Hahm KB, Iwakiri R, Watanabe T, Rani AA, et al. Management of Gastroesophageal Reflux Disease in Asian Countries: Results of a Questionnaire Survey. Digestion. 2019 Dec 4;101(1):66–79.

Ebell MH. Diagnosis of gastroesophageal reflux disease. Am Fam Physician. 2010 May 15;81(10):1278.

Hojo M, Nagahara A, Hahm KB, Iwakiri R, Watanabe T, Rani AA, et al. Management of Gastroesophageal Reflux Disease in Asian Countries: Results of a Questionnaire Survey. Digestion. 2020; 101(1):66–79.

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. Journal of Gastroenterology [Internet]. [cited 2024 May 6].

Dammann HG, Burkhardt F. Pantoprazole versus omeprazole: influence on meal-stimulated gastric acid secretion. Eur J Gastroenterol Hepatol. 1999 Nov;11(11): 1277–82.

Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008 Oct;135(4):1383–91.

Gallo S, Dibildox M, Moguel A, Di Silvio M, Rodríguez F, Almaguer I, et al. Clinical superiority of pantoprazole over ranitidine in the treatment of reflux esophagitis grade II and III. A prospective, double-blind, double-placebo study. Mexican clinical experience. Mexican Pantoprazole Study Group. Rev Gastroenterol Mex. 1998; 63(1):11–6.

Meneghelli U, Boaventura S, Prado Moraes-Filho J, Leitão O, Ferrari A, Almeida J, et al. Efficacy and tolerability of pantoprazole versus ranitidine in the treatment of reflux esophagitis and the influence of Helicobacter pylori infection on healing rate. Diseases of the esophagus: official journal of the International Society for Diseases of the Esophagus/ ISDE. 2002 Feb 1;15:50–6.

Zamani NF, Sjahid AS, Tuan Kamauzaman TH, Lee YY, Islam MA. Efficacy and Safety of Domperidone in Combination with Proton Pump Inhibitors in Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. J Clin Med. 2022 Sep 7;11(18):5268.

Zamani NF, Sjahid AS, Tuan Kamauzaman TH, Lee YY, Islam MA. Efficacy and Safety of Domperidone in Combination with Proton Pump Inhibitors in Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. J Clin Med. 2022 Sep 7;11(18): 5268.

Singhal S, Dhawan P, Bhatt A, Pokharna R, Sharma D, Kumar G, et al. Evaluation Of Safety And Efficacy Of Pantoprazole And Domperidone Combination In Patients With Gastroesophageal Reflux Disease. The Internet Journal of Gastroenterology. 2005;4(2):1-7.