School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton-on-Tees, United Kingdom.
Clin Gastroenterol Hepatol. 2012 Feb;10(2):109-16. doi: 10.1016/j.cgh.2011.07.008. Epub 2011 Jul 23.
BACKGROUND & AIMS: Variation in how proton pump inhibitors (PPIs) are taken likely influences their clinical effectiveness, and must be considered when estimating PPI failure rates. This review aimed to systematically investigate the literature on patterns of PPI use in patients with gastroesophageal reflux disease (GERD).
PubMed and Embase were searched (1989-May 2010) to identify observational studies providing information on patterns of PPI use in patients with GERD.
Of 902 studies identified, 13 met prespecified selection criteria. Across 2 database studies, 53.8%-67.7% of patients with GERD had a medication possession ratio (MPR) of >0.80. Across 2 more database studies, the mean MPR for the study population was 0.68 to 0.84. Across 3 surveys, 70%-84% of patients reported daily PPI use. In 2 surveys, the presence and severity of reflux symptoms increased PPI adherence, as did Barrett's esophagus in another 2 studies. Across 3 surveys, 11%-22.2% of patients reported twice daily PPI use, and across 6 studies 11.0%-44.8% of patients took GERD medication in addition to a PPI.
The results of this systematic review suggest that the majority of patients with GERD are relatively adherent to their PPI, although substantially different estimates were obtained using MPR data compared with surveys. Severe symptoms and the presence of Barrett's esophagus may increase PPI adherence, and other GERD medication is frequently taken in addition to a PPI. Limitations of studies in this area include inferring adherence from indirect MPR data, and recall bias associated with patient surveys.
质子泵抑制剂（PPIs）的服用方式可能会影响其临床疗效，在估计 PPI 失败率时必须加以考虑。本综述旨在系统地调查胃食管反流病（GERD）患者中 PPI 使用模式的文献。
在 PubMed 和 Embase 中进行检索（1989 年 5 月-2010 年），以确定提供 GERD 患者 PPI 使用模式信息的观察性研究。
在 902 项研究中，有 13 项符合预先规定的选择标准。在 2 项数据库研究中，有 53.8%-67.7%的 GERD 患者的药物持有率（MPR）＞0.80。在另外 2 项数据库研究中，研究人群的平均 MPR 为 0.68-0.84。在 3 项调查中，有 70%-84%的患者报告每天使用 PPI。在 2 项调查中，反流症状的存在和严重程度增加了 PPI 的依从性，另外 2 项研究中 Barrett 食管也是如此。在 3 项调查中，有 11%-22.2%的患者报告每天使用 2 次 PPI，在 6 项研究中有 11.0%-44.8%的患者除 PPI 外还使用 GERD 药物。
本系统综述的结果表明，大多数 GERD 患者对其 PPI 的依从性相对较高，尽管使用 MPR 数据与调查结果相比获得了截然不同的估计。严重的症状和 Barrett 食管的存在可能会增加 PPI 的依从性，并且除 PPI 外还经常使用其他 GERD 药物。该领域研究的局限性包括从间接 MPR 数据推断依从性以及与患者调查相关的回忆偏倚。
