Functional Dyspepsia Patients: Medication Risk Taking Behavior

Abstract

Purpose: Functional dyspepsia (FD) is a highly prevalent disorder that reduces patients' quality of life. No medication is FDA approved for the treatment of FD. The medication risks that patients would be willing to take to cure their FD symptoms are unknown. Methods: Adult patients (Pts) evaluated at an academic medical center who met Rome III criteria for FD were eligible for inclusion. Each Pt was mailed a questionnaire that assessed demographics, medications used to treat FD symptoms, and previous medication adverse events. Scales to measure FD severity, quality of life, anxiety, depression, impulsiveness, and risk taking behavior were included. A standard gamble (SG) evaluated willingness to take risks associated with a theoretical FD medication. Data were analyzed using simple descriptive statistics. Results: 116 responses were analyzed (50.4% response rate). The mean age of Pts was 49 ± 16 yrs; 84% were women, 96% were white. The mean duration of symptoms was 8.2 ± 6.9 yrs (range 1 - 38 yrs). Patients reported a mean of 3.8 ± 2.2 days/week with FD symptoms. The most bothersome symptom was upper abdominal discomfort (24%), followed by upper abdominal pain (23%) and bloating (15%). 40% of respondents rated their FD symptoms as moderate, 32% mild, and 27% as severe. 26% of Pts described themselves as taking risks occasionally, 31% as rarely taking risks, and 25% as never taking risks. 65% of Pts reported having life insurance and 98% had health insurance. The mean anxiety and depression subscores using the HAD questionnaire was 8.03 (+ 4.9) and 4.8 (+ 4.3), respectively. 78% of Pts had been treated with a PPI for their FD symptoms, 37% had been treated with a TCA, and 35% with an SSRI. 69% reported developing a side effect from a prescription medication, while 47% reported developing a side effect from a prescription medication used to treat FD. When asked about a hypothetical medication that could cure their FD symptoms, 49% of respondents reported that they would accept a mean 13.2% risk of sudden death (range 1-90%) for a 99% chance of cure. Conclusion: This prospective study suggests that FD patients are surprisingly willing to take significant risks with a hypothetical medication in order to cure their symptoms. In order to counsel patients effectively and assist in the development of informed, preference-based decisions on medication therapy, physicians need to elicit and understand FD patients' risk adversity.