gms | German Medical Science

Background: Proton pump inhibitors (PPI) are used to treat peptic disorders, like gastro-esophageal disease (GERD) and ulcer, but non-responder patients refractory to PPI treatment are very common [1]. An activation of the gastric H+/K+-ATPase (proton pump) is necessary for PPIs to inhibit them efficiently [2]. Therefore a stimulus like food seems to be necessary to obtain a sufficient suppression of gastric acid [3]. We aimed to investigate the association between conditions of PPI treatment failure and food intake in an elderly ambulatory population

Materials and Methods: Our data originate from the ESTHER-study, a large population-based cohort study conducted in Saarland, Germany. During a home visit done by a trained study physician patients were asked for each medication to state whether it was taken before, concurrently with, after, or independent of a meal. A synchronized intake of PPI and food was defined as correct intake and included an intake before, with, or after a meal. In contrast, if a PPI was taken independently of a meal it was considered to be incorrect. Treatment failure was defined as i) intake of a second drug for acid related disorders (antacids, H2-receptor antagonists, second PPI, other drugs with ATC-Code A02BX), ii) intake of high daily doses (exceeding approved doses), iii) self-reported unauthorized increase of PPI dose, iv) newly diagnosed ulcer during PPI treatment. This information was analyzed for all patients taking a PPI daily and correlated to markers of PPI failure. Potential confounders (age, sex, body-mass index, multi-morbidity, non-adherence, ulcerogenic co-medication, alcohol intake, smoking status) were considered. Univariate and multiple logistic regressions were performed to estimate the odds of treatment failure. Categorial data were compared using chi-square test or Fisher’s exact test and metric data were compared calculating t-test. A p-value <0.05 was considered statistically significant.

Results: In total, 3,124 participants were visited by a study physician with 2,717 of them taking at least one medication. PPI usage was observed in 516 patients with 383 participants taking them daily and therefore being included in this analysis. A synchronized intake of PPI was determined in 319 patients (83.3%), whereas 64 patients (16.7%) took their medication independent of food. Conditions suggesting treatment failure were observed in 10 (15.6%) of the 64 patients taking PPI independent of meals and in 18 (5.6%) of 319 patients with an intake related to food. The risk for treatment failure was threefold increased (OR 3.10; 95%CI 1.36–7.07, p <0.05) also when adjusted for age and sex. There were no significant differences of patient characteristics between the two groups.

Conclusion: The risk for PPI failure was 3-fold higher in patients taking PPI independent of meals suggesting that synchronized PPI administration with meals is indeed essential and better counseling of patients is needed.