Patient journey in erosive oesophagitis: real-world perspectives from US physicians and patients

Michael F Vaezi; Stephen Brunton; A Mark Fendrick; Colin W Howden; Christian Atkinson; Corey Pelletier; Rinu Jacob; Stuart J Spechler

doi:10.1136/bmjgast-2022-000941

Patient journey in erosive oesophagitis: real-world perspectives from US physicians and patients

BMJ Open Gastroenterol. 2022 Jul;9(1):e000941. doi: 10.1136/bmjgast-2022-000941.

Authors

Michael F Vaezi¹, Stephen Brunton², A Mark Fendrick³, Colin W Howden⁴, Christian Atkinson⁵, Corey Pelletier⁶, Rinu Jacob⁶, Stuart J Spechler⁷

Affiliations

¹ Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA michael.vaezi@vumc.org.
² Primary Care Education Consortium, Winnsboro, Texas, USA.
³ Department of Internal Medicine, University of Michigan Department of Internal Medicine, Ann Arbor, Michigan, USA.
⁴ University of Tennessee, Tennessee, Nashville, USA.
⁵ Adelphi Real World, Bollington, Cheshire, UK.
⁶ Phathom Pharmaceuticals, New Jersey, New Jersey, USA.
⁷ Division of Gastroenterology, Baylor University Medical Center at Dallas, Dallas, Texas, USA.

Abstract

Objective: Management of erosive oesophagitis (EE) remains suboptimal, with many patients experiencing incomplete healing, ongoing symptoms, and relapse despite proton pump inhibitor (PPI) treatment. The Study of Acid-Related Disorders investigated patient burden of individuals with EE in a real-world setting.

Design: US gastroenterologists (GIs) or family physicians (FPs)/general practitioners (GPs) treating patients with EE completed a physician survey and enrolled up to four patients with EE for a patient survey, with prespecified data extracted from medical records.

Results: 102 GIs and 149 FPs/GPs completed the survey; data were available for 73 patients (mean age at diagnosis, 45.4 years). Omeprazole was healthcare professional (HCP)-preferred first-line treatment (60.8% GIs; 56.4% FPs/GPs), and pantoprazole preferred second line (29.4% and 32.9%, respectively). Price and insurance coverage (both 55.5% HCPs) and familiarity (47.9%) key drivers for omeprazole; insurance coverage (52.0%), price (50.0%), familiarity (48.0%), initial symptom relief (46.0%), and safety (44.0%) key drivers for pantoprazole. Only 49.3% patients took medication as instructed all the time; 56.8% independently increased medication frequency some of the time. Despite treatment, 57.5% patients experienced heartburn and 30.1% regurgitation; heartburn was the most bothersome symptom. 58.9% patients believed that their symptoms could be better controlled; only 28.3% HCPs were very satisfied with current treatment options. 83.6% patients wanted long-lasting treatment options. Fast symptom relief for patients was a top priority for 66.1% HCPs, while 56.6% would welcome alternatives to PPIs.

Conclusion: This real-world multicentre study highlights the need for new, rapidly acting treatments in EE that reduce symptom burden, offer durable healing and provide symptom control.

Keywords: EROSIVE OESOPHAGITIS; GASTROESOPHAGEAL REFLUX DISEASE; QUALITY OF LIFE.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

2-Pyridinylmethylsulfinylbenzimidazoles / therapeutic use
Anti-Ulcer Agents* / adverse effects
Benzimidazoles / adverse effects
Esophagitis* / chemically induced
Esophagitis* / drug therapy
Esophagitis* / epidemiology
Gastroesophageal Reflux* / drug therapy
Gastroesophageal Reflux* / epidemiology
Heartburn / chemically induced
Heartburn / drug therapy
Humans
Omeprazole / therapeutic use
Pantoprazole / therapeutic use
Peptic Ulcer* / chemically induced
Peptic Ulcer* / drug therapy
Physicians*
Proton Pump Inhibitors / therapeutic use

Substances

2-Pyridinylmethylsulfinylbenzimidazoles
Anti-Ulcer Agents
Benzimidazoles
Proton Pump Inhibitors
Pantoprazole
Omeprazole