Gastric acid-related disorders and drugs: An epidemiological perspective

Gastroesophageal reflux disease (GERD) is an important health problem for several reasons. First, GERD is highly prevalent. GERD symptoms are experienced by more than 25% of the general population on at least a monthly basis. Secondly, GERD has a substantial impact on quality of life. Thirdly, GERD may lead to complications, such as esophageal strictures, Barrett’s esophagus and ultimately to esophageal adenocarcinoma (EAC). The primary goals of treatment of GERD are to achieve relief of symptoms as well as to prevent complications. The most common pharmacological treatment consists of proton pump inhibitors (PPIs). With this thesis we aimed to give insight into the epidemiology of and risk factors for GERD and associated diseases, and on usage patterns, efficacy and safety of proton pump inhibitors in daily clinical practice. We made use of the Integrated Primary Care Information (IPCI) database which is a general practitioner research database, containing the complete longitudinal electronic medical records of more than 800,000 patients in the Netherlands. The main findings of the studies described in this thesis include that the incidence of Barrett’s esophagus is increasing, mainly among men under 60 years of age. The incidence of EAC is increasing as well. Furthermore we showed that the use of tricyclic antidepressants, with the exception of clomipramine, does not increase the risk of reflux esophagitis. Also for other anticholinergic drugs there is no solid evidence for such an association. With regard to PPIs, we described usage patterns in daily clincial practice and concluded that the risk of NSAID-related gastrointestinal complications is increased 4-fold in patients who are not adherent to PPI therapy. PPIs were not associated with an increased risk of colorectal cancer.

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