Drugs for Dyspepsia – Prescribing Guidance and Discussion Points

PCT Board Prescribing Report (August 2010)

Drugs for Dyspepsia – Prescribing Guidance and Discussion Points

1. Has your PCT reviewed local clinical guidelines and protocols for the management of dyspepsia against the NICE guideline?

2. Does your PCT provide prescribing guidance which is consistent with the NICE guideline on dyspepsia? Does this include:

• recommending an annual review for patients to offer advice on stepping down proton pump inhibitor (PPI) treatment to the lowest effective dose?

• recommending discussing the possibility of using ‘on demand’ treatment with patients to manage their symptoms

3. In line with one of the NHS Institute for Innovation and Improvement Better Care, Better Value ‘Indicators’, does your PCT audit the percentage of items written for omeprazole and lansoprazole (excluding Zoton FasTab® and Losec MUPS®) as a percentage of the total volume of prescribing of PPIs?

Dyspepsia is defined by the NICE Clinical Guideline for the management of dyspepsia (August 2004) as any symptom of the upper gastrointestinal (GI) tract, present for 4 weeks or more, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea or vomiting. Dyspepsia occurs in 40% of the population, leads to GP consultation in 5% and referral for endoscopy in 1% each year. In patients with symptoms severe enough to merit endoscopy 40% will have non-ulcer dyspepsia (NUD), 40% will have gastro-oesophageal reflux disease (GORD) and 13% will have some form of ulcer detected. Gastric and oesophageal cancers are seen in less than 3% of patients who have endoscopy and many of these cases are found during investigation for other symptoms, rather than following primary care referral for dyspepsia.

Over the last 5 years the prescribing of drugs used for dyspepsia has increased from 7.6 million items per quarter to 11.5 million items per quarter (figure 1) whilst costs have nearly halved from £122 million to £62 million per quarter (figure 2). The prescribing of PPIs has increased by 79% over this time period and PPIs now (quarter to March 2010) account for 81% of items (9.3 million) and 86% of the cost (£52.9 million) of drugs used for dyspepsia. Omeprazole is the most commonly prescribed PPI, 4.9 million items costing £24.2million, followed by lansoprazole with 3.8 million items and a cost of £11.4 million (quarter to March 2010).

http://www.nhsbsa.nhs.uk/Documents/PPDPCTReports/pctreport_20101.pdf