LONG-TERM ACID SUPPRESSING TREATMENT IN GENERAL-PRACTICE

Objective-To determine the current practice in selected general practi ces for prescribing long term (>6 months) treatment to suppress gastri c acid secretion. Setting-Seven general practices in the Harrow area t hat always or usually refer to Northwick Park Hospital. Subjects-60148 patients on lists of the general practices. Design-Identification of patients receiving long term treatment through repeat prescribing data followed by a manual and computer survey of patients' notes for indic ations and investigations Patient compliance and views on treatment we re sought by a postal questionnaire. Main outcome measures-Indications for treatment, treatment given, investigations undertaken before and during treatment. Results-492 patients (0.82% of the population) were taking long term acid suppressing treatment The most common diagnosis was duodenal ulcer disease (183 (37%) of all patients); oesophageal di sease (118 (24%)) was also common. 93 patients (19%) were treated for abdominal pain where no diagnosis had been reached or who had only a d iagnosis of gastritis on endoscopy. Ranitidine was prescribed in 394 ( 80%) patients. 298 (74%) patients found treatment helpful, but 108 (27 %) had a poor understanding of their diagnosis. 317 patients (78%) too k their drug as prescribed. 37 patients were also taking prescribed no n-steroidal anti-inflammatory drugs and an additional 43 patients took regular aspirin or ibuprofen without prescription. Conclusions-Long t erm acid suppressing treatment is common, and a substantial number of patients are taking these drugs long term without a diagnosis having b een reached. It is hoped that protocols for investigation and treatmen t will improve these figures. Patients need to be better informed abou t their disease and the possible adverse effects of taking non-steroid al anti-inflammatory drugs in acid related upper gastrointestinal dise ase.