Ellenbogen MI, Gawron AJ, Shintani-Smith S, Pandolfino JE. Gastroenterology. 2013 May;144(5):S-838.
OBJECTIVES: To determine 1) PPI prescriptions, diagnoses, and testing in patients seen by ENT and 2) Compare agreement in PPI prescriptions, diagnoses, and testing in patients also seen by GI.
RESULTS: 2,427 patients were provided a new PPI prescription by ENT between 2005 and 2011. Patients were 52.2 yrs of age (sd 15.4) and predominantly female (56.4%), white (58.1%), and non-Hispanic (65.6%). Esomeprazole accounted for the greatest number of prescriptions (722, 29.8%), followed by omeprazole (582, 24.0%). Of patients given a PPI prescription, the primary, secondary, or tertiary ENT diagnosis was reflux (GERD, LPR) in 1,018 patients (41.9%). Other diagnoses are listed in Table 1. Diagnostic laryngoscopy was performed in 672 encounters (27.7%). A total of 140 patients (5.8% of 2,427) also saw GI (90 after ENT, 48 prior to ENT, and 2 on the same day). Of these 140 patients, 94 (67.1%) were given a standard diagnosis of GERD by GI and 33 (23.6%) were documented to have extra-esophageal symptoms (e.g. sore throat, globus). GI and ENT agreed 55.7% of the time in a standard reflux diagnosis (kappa statistic = 0.08). GI diagnoses, including extra-esophageal symptoms, supported reflux in 81.4% of patients who were prescribed a PPI by ENT. GI and ENT prescribed the same PPI in 73 patients (59.8%). PPI dose and frequency were the same in 78 (70.9%) and 77 patients (63.6%), respectively. Instructions on PPI timing were the same in 57 patients (47.1%). Laryngoscopy was performed in 135 patients, and 90 of these exams showed evidence of reflux. Upper endoscopy was performed in 96 patients (34.4% with hiatal hernia, 13.5% with esophagitis) and 19 had pH testing (11 with positive results for reflux). Of 17 patients with pH testing and laryngoscopy, 5 (29.4%) had evidence of reflux on both tests.
CONCLUSION: In patients evaluated by ENT and GI, agreement in diagnosis of standard reflux disease is poor, PPI prescriptions between the two specialties are highly variable, and esophageal reflux testing is rarely used. Future work should focus on increased efforts to coordinate care and align management strategies for this group.