Costs and risks in the management of patients with gastric acid hypersecretion.

Abstract:

GOALS:To define both risks and costs of optimal care of patients with gastric acid hypersecretion. BACKGROUND:The management of Zollinger-Ellison syndrome and other gastric acid hypersecretory disorders remains challenging. The optimal strategy for follow-up including gastric acid analysis, laboratory studies, and endoscopy is unknown but important given the potential complications from uncontrolled acid secretion. STUDY:Over the last 18 years, patients with gastric acid hypersecretory disorders have been followed prospectively with gastric acid analysis and endoscopy titrating oral lansoprazole and evaluating for complications. Protocol driven charges were calculated using the most recent information available. RESULTS:After 1 year of treatment optimization, 19 of 67 patients had 43 relapses, (once only in 10 patients). Risk markers for relapse included: (1) antrectomy, 67% relapsed versus 21% in unoperated patients; (2) basal acid output >5 mmol/h (risk=5.17); and (3) poor compliance. On treatment, 79% of 58 intact patients (excluding antrectomy) were lesion-free; 11% had only 1 relapse. Thus 90% were well managed with optimized lansoprazole alone. Protocol driven charges exceeded $25,000 the first year and $7000 annually thereafter. CONCLUSIONS:Relapse is infrequent and generally mild with acid secreting status closely monitored. The ideal strategy to balance costs and testing awaits further study.

journal_name

J Clin Gastroenterol

authors

Hirschowitz BI,Fineberg N,Wilcox CM,Mohnen J,Worthington J

doi

10.1097/MCG.0b013e3181a59aa5

subject

Has Abstract

pub_date

2010-01-01 00:00:00

pages

28-33

issue

1

eissn

0192-0790

issn

1539-2031

journal_volume

44

pub_type

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