Tu1078 The Role of Confocal Laser Endomicroscopy in the Management of Patients With Barrett's Esophagus: A Clinical Evidence-Based Consensus Report

Abstract

Background: Abdominal pain is a common reason for ER visits. Acid suppression therapy (AST) using proton pump inhibitors and H2-blockers is commonly prescribed in ER for abdominal pain. As inappropriate use of AST can contribute to drug interactions, pneumonia, and increased health care expenditure, we wanted to look for factors which influence prescribing patterns of AST in ER. Objectives: To evaluate if age, gender differences, severity of abdominal pain and length of ER stay influence prescription of acid suppression therapy (AST) in patients presenting to ER with abdominal pain. Methods: We analyzed the limited access dataset of National Hospital Ambulatory Medical Care Survey (2006 to 2009) for ER visits. We included all patients above 15 years of age presenting to ER with upper abdominal pain. We calculated and compared AST prescription rates based on age, gender, severity of pain and length of ER visit. Statistical analysis was done using multivariate logistic regression. Results: There were a total of 1, 12,810 patient visits. Of these, 11,496 visits were for abdominal pain consisting of 70% women and 30% men. Men were 36% more likely to receive AST compared to women (OR 1.35 95% CI 1.18 to 1.57). Patients in age group 45-64 years were more likely to receive AST compared to younger age groups (OR 1.32 CI 1.11 to 1.56). Patients with ER visit longer than 9 hours were more likely to receive AST compared to shorter ER visits (OR 1.82 CI 1.43 to 2.30). Patients with severe abdominal pain were more likely to receive AST compared to patients with milder degree of pain (OR 1.37 CI 1.08 to 1.74). Conclusion: Age, gender differences, length of ER visit and severity of abdominal pain have significant impact on the prescription of AST for the treatment of abdominal pain in ER. The higher prevalence of gastritis/ ulcers in men and presence of additional sources of abdominal pain in women could explain the higher prescription rate in men. Middle aged patients have higher AST prescription rate which probably reflects the higher prevalence of upper GI pathology as patients get older. A tendency to prescribe AST when a definite diagnosis is not reached or when pain is refractory could explain the higher prescription rates in patients with longer ER visits and severe abdominal pain. Further studies are needed to investigate and frame guidelines for appropriate use of AST.