Prescribing pattern of proton pump inhibitors in the management of acid peptic disorders, focus on ilaprazole

Background: Acid peptic disorders (APDs) result from characteristic but overlapping pathogenic mechanisms that involve acid effects on diminished mucosal defense. Proton pump inhibitors (PPIs) have become a mainstay in the APDs. This survey was aimed to determine the usage profile of different proton pump inhibitors and overall physicians’ opinion about the clinical experience with newer PPI, ilaprazole.Methods: This survey was based on the clinical experience of 107 randomly selected physicians on an aggregate patient basis in the management of acid-peptic disorders from different parts of India. A data report form (DRF) comprising of various questions was answered by these physicians. The responding physicians answered the DRF of patients who suffered from acid-peptic disorders and were eligible for PPI therapy. A minimum of 50 patients per physician were evaluated in this survey.Results: The commonly encountered APD in physicians’ clinical practice were gastroesophageal reflux disorder (GERD) followed by non-ulcer disease. 58.88% physicians highlighted the prevalence of night time symptoms of APD reported by the patients. About 1/4th physicians were of the opinion that long-acting PPIs would be the preferred to offer 24 hour control of gastric acid secretion thereby controlling the nocturnal symptoms. 63.73% of physicians reported significantly better symptomatic relief with once daily dose of ilaprazole than existing PPIs.Conclusions: This survey highlights the lack of 24 hour acid control in APDs with use of conventional PPIs leading to variety of symptoms, especially at night, seriously hampering the sleep quality. Ilaprazole displays important advantages in the clinical settings, with regard to better probability of extending the inhibition of acid secretion over 24 hours as compared to conventional PPIs

Clinical profiling of patients with Acid Peptic Disorders (APD) in India: a cross-sectional survey of clinicians

Background: Acid peptic disorders (APD) which include GERD and peptic ulcer disease (PUD) are common conditions reported in daily clinical practice. This survey aimed to understand the epidemiology, clinical presentation and associated overlapping comorbidities in Indian patients with APD.Methods: This was an interview based cross-sectional survey of 1000 clinicians (specialist gastroenterologists and non-specialists) across India who treated patients of APD in their practice. Information related to patient demographics, diagnosis and clinical presentation (common symptoms and their duration, alarming, lower GI and extra-esophageal symptoms) were assessed. Indications for upper GI endoscopy, esophageal pH monitoring and esophageal manometry were also collected. Descriptive analyses were done.Results: About 39.2% and 37.1% patients had reported GERD and PUD respectively (duodenal ulcer: 10.5%, gastric ulcer: 9.9% and peptic ulcer-non-specified: 16.7%); 25.2% patients were reported to have non-ulcer dyspepsia. Heartburn was the most common symptom in GERD (60.5%); epigastric pain was common in PUD (72.3%); 49% GERD patients presented with alarming symptoms, mainly dysphagia (67%), whereas for PUD, GI bleeding was the most common alarming symptom (47.6%). Profiles of patients visiting clinicians were similar with respect to the presenting symptoms and associated conditions. Functional dyspepsia (25.9%), constipation (23.4%) and irritable bowel syndrome (23.4%) were the most common overlapping conditions associated with both GERD and PUD.Conclusions: APD (GERD and PUD) was more common in 18-59 yrs. age group with heart burn as the common symptom for GERD and epigastric pain for PUD. Diagnosis was mostly based on clinical symptoms; nearly 50% patients of APD presenting with alarming symptoms needed prompt endoscopy. Thus, there is need to focus on these overlapping disorders while managing patients of APD

Prevalence of functional constipation and constipation-predominant irritable bowel syndrome in Indian patients with constipation

Background: Evaluate prevalence of functional constipation (FC) and irritable bowel syndrome-constipation (IBS-C) in Indian constipated patients and assess their demographic/socio-economic/clinical characteristics.Methods: Patients (≥18 years) who visited their general physician with symptoms of constipation (Rome III criteria for FC or IBS-C as per physician assessment) and willing to participate were enrolled in this prospective, clinical-epidemiological study. Demographic, socioeconomic status, lifestyle and dietary habits, comorbid conditions, treatment history, concomitant medications, stool form (Bristol stool form scale), severity of constipation (constipation scoring system [CSS]), constipation-related symptoms (patient assessment of constipation symptoms [PAC-SYM]) and quality of life (patient assessment of constipation-quality of life questionnaire [PAC-QoL]) were recorded.Results: Out of 925 constipated patients, 75.6% were diagnosed with FC against 24.4% with IBS-C (P < 0.0001). Patients of both subtypes had high average scores of PAC-SYM (FC: 27.1 ± 6; IBS-C: 30.1 ± 4.9) and CSS (FC: 8.4 ± 3.1; IBS-C: 11.2 ± 3), leading to high PAC-QoL score (FC: 38.1 ± 16.8; IBS-C: 42.2 ± 13.6). Hypertension (16%) and diabetes (10%) in patients with FC while acid peptic disorders (21.7%) amongst IBS-C patients were the most common comorbid conditions observed. Laxatives were the most common medication used; osmotic (32.6% versus 40.7%) and bulk laxatives (22.8% versus 37.4%) were the commonest laxatives. However, about 1/5th patients of FC were using home remedies.Conclusions: There was a higher prevalence of FC over IBS-C in Indian constipated patients; both subtypes had high frequency and severity of constipation-related symptoms and poor QoL

Cognitive and psychomotor effects of adjunctive aripiprazole or paliperidone in patients of schizophrenia receiving olanzapine: a double blind placebo controlled clinical study

Background: Emergence of atypical antipsychotics has revolutionized the treatment of schizophrenia by exploiting dual actions on serotonin as well as dopaminergic receptors. Still, monotherapy with these agents is insufficient to control cognitive and psychomotor as well as positive and negative symptoms. Hence combination therapy with antipsychotics is common in clinical practice. Objective of current study is to compare the effects of addition of aripiprazole or paliperidone on cognition and psychomotor functions in schizophrenia receiving olanzapine.Methods: This is prospective, double blind, placebo controlled, parallel group study in 90 patients of schizophrenia showing partial or no response to olanzapine measured by Positive And Negative Symptoms Score (PANSS) scale. They were randomly divided to receive adjuvant aripiprazole, paliperidone or placebo for 6 weeks.Results: Combination of aripiprazole and olanzapine shows significant improvement in most of the cognition and psychomotor parameters like attention, perception, verbal memory, thinking and processing as well as motor speed while combination of paliperidone and olanzapine is associated with improvement in only some of the cognitive and psychomotor parameters such as attention, perception and verbal memory only. Both the combinations are efficacious in controlling positive and negative symptoms of schizophrenia as assessed by PANSS scale.Conclusions: The best augmenting strategy with for olanzapine nonresponsive patients will be D2 receptor partial agonist like aripiprazole rather than D2 antagonist like paliperidone and other atypical antipsychotic agents for better improvement in cognition and psychomotor domains

Prescribing pattern of proton pump inhibitors in the management of acid peptic disorders, focus on ilaprazole

Background: Acid peptic disorders (APDs) result from characteristic but overlapping pathogenic mechanisms that involve acid effects on diminished mucosal defense. Proton pump inhibitors (PPIs) have become a mainstay in the APDs. This survey was aimed to determine the usage profile of different proton pump inhibitors and overall physicians’ opinion about the clinical experience with newer PPI, ilaprazole.Methods: This survey was based on the clinical experience of 107 randomly selected physicians on an aggregate patient basis in the management of acid-peptic disorders from different parts of India. A data report form (DRF) comprising of various questions was answered by these physicians. The responding physicians answered the DRF of patients who suffered from acid-peptic disorders and were eligible for PPI therapy. A minimum of 50 patients per physician were evaluated in this survey.Results: The commonly encountered APD in physicians’ clinical practice were gastroesophageal reflux disorder (GERD) followed by non-ulcer disease. 58.88% physicians highlighted the prevalence of night time symptoms of APD reported by the patients. About 1/4th physicians were of the opinion that long-acting PPIs would be the preferred to offer 24 hour control of gastric acid secretion thereby controlling the nocturnal symptoms. 63.73% of physicians reported significantly better symptomatic relief with once daily dose of ilaprazole than existing PPIs.Conclusions: This survey highlights the lack of 24 hour acid control in APDs with use of conventional PPIs leading to variety of symptoms, especially at night, seriously hampering the sleep quality. Ilaprazole displays important advantages in the clinical settings, with regard to better probability of extending the inhibition of acid secretion over 24 hours as compared to conventional PPIs

Clinical profiling of patients with Acid Peptic Disorders (APD) in India: a cross-sectional survey of clinicians

Background: Acid peptic disorders (APD) which include GERD and peptic ulcer disease (PUD) are common conditions reported in daily clinical practice. This survey aimed to understand the epidemiology, clinical presentation and associated overlapping comorbidities in Indian patients with APD.Methods: This was an interview based cross-sectional survey of 1000 clinicians (specialist gastroenterologists and non-specialists) across India who treated patients of APD in their practice. Information related to patient demographics, diagnosis and clinical presentation (common symptoms and their duration, alarming, lower GI and extra-esophageal symptoms) were assessed. Indications for upper GI endoscopy, esophageal pH monitoring and esophageal manometry were also collected. Descriptive analyses were done.Results: About 39.2% and 37.1% patients had reported GERD and PUD respectively (duodenal ulcer: 10.5%, gastric ulcer: 9.9% and peptic ulcer-non-specified: 16.7%); 25.2% patients were reported to have non-ulcer dyspepsia. Heartburn was the most common symptom in GERD (60.5%); epigastric pain was common in PUD (72.3%); 49% GERD patients presented with alarming symptoms, mainly dysphagia (67%), whereas for PUD, GI bleeding was the most common alarming symptom (47.6%). Profiles of patients visiting clinicians were similar with respect to the presenting symptoms and associated conditions. Functional dyspepsia (25.9%), constipation (23.4%) and irritable bowel syndrome (23.4%) were the most common overlapping conditions associated with both GERD and PUD.Conclusions: APD (GERD and PUD) was more common in 18-59 yrs. age group with heart burn as the common symptom for GERD and epigastric pain for PUD. Diagnosis was mostly based on clinical symptoms; nearly 50% patients of APD presenting with alarming symptoms needed prompt endoscopy. Thus, there is need to focus on these overlapping disorders while managing patients of APD