Prescription of acid-suppressing drugs in relation to endoscopic diagnosis: a record-linkage study

Background: Although widely used, few data are available on the appropriate ness of prescribing of acid-suppressing drugs (ASDs), despite guidelines on the investigation and treatment of dyspeptic patients. Methods: We created a database of 62 000 endoscopy examinations and record- linked these to a prescribing database. Endoscopic diagnoses were classifie d into peptic, nonpeptic and others. The H-2-antagonists, omeprazole and mi soprostol, were studied. Results: 35 000 patients had one or more endoscopies during 1978-93; two-th irds were over 45 years of age at first endoscopy, A quarter of all patient s who had been endoscoped had consistently normal examinations, Peptic oeso phageal pathology was the commonest positive finding. A quarter of those pr escribed ASDs between 1989 and 1993 had been endoscoped between 1978 and 19 93, In those with a peptic diagnosis prescribed any ASD, the pathologies fo und were: oesophageal (42,9%), duodenal (36.3%) and gastro-pyloric (21,3%), Patients prescribed omeprazole were more likely to have undergone endoscop y than those prescribed other ASDs, and they were also more likely to have peptic oesophageal pathology. Long-term prescribing (>56 days per year) occ urred in two-thirds of patients prescribed ASDs and 40% had at least one en doscopy, In those prescribed short-term ASDs, 20% had undergone at least on e endoscopy. Peptic and nonpeptic endoscopic pathology was associated with increased ASD prescribing, but a normal endoscopy did not reduce prescribin g. Conclusion: ASD prescribing appeared to be mainly symptom-driven. Positive endoscopic findings increased the prescribing of ASDs, but normal findings did not reduce it.