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For Indigestion, Cheaper May Be Just As Good
 Digestive Disorders Center Feature Story

For Indigestion, Cheaper May Be Just As Good
Study finds antacids work as well as more expensive drugs

For Indigestion, Cheaper May Be Just As Good(HealthDay News) -- If indigestion is the problem, starting with simple antacids might be best.

While antacids, proton pump inhibitors and H2-receptor antagonists can all treat the many types of indigestion, there are no consistent guidelines on how to use these drugs, say the authors of a study that compared their effectiveness. And, treatment decisions are further complicated, they said, because there's no uniform definition for indigestion, which has a wide range of symptoms and possible causes.

In many cases of new-onset dyspepsia -- the medical term for indigestion -- treatment decisions are based on observation more than testing, the researchers said. Dr. Robert Laheij, a gastroenterologist at Radboud University Nijmegen Medical Center in the Netherlands, and senior author of the study, said that doctors tend to prescribe more expensive proton pump inhibitor drugs, such as Prilosec, Prevacid and Nexium.

This makes proton pump inhibitors among the most commonly prescribed drugs worldwide, leading to higher treatment costs, Laheij said.

"Overall, most patients with dyspepsia could and should be managed with antacids and H2-receptor antagonists instead of treatment with proton pump inhibitors," he told HealthDay. "Treatment with proton pump inhibitors should be reserved for those not responding to antacids or H2-receptor antagonists."

His study, reported in The Lancet, included 664 adults who'd been recently diagnosed with indigestion. They were randomly assigned to what the researchers called either "step-up" or "step-down" treatment.

The step-up approach involved treatment with antacids, then H2-receptor antagonists and finally proton pump inhibitors. The step-down group started on proton pump inhibitors and worked down to antacids. Each treatment lasted four weeks. Participants moved to the next step only if their symptoms persisted.

Treatment success was 72 percent in the step-up group and 70 percent in the step-down group, the study reported. Side effects were minor and nearly equivalent in both groups.

Average medical costs were $299 per person in the step-up group and $322 per person in the step-down group. The study attributed the difference mainly to the cost of medication.

However, one expert not associated with the study described the cost difference as tiny. And because the responses in both groups were similar, "this is nothing terribly exciting," Dr. Maria T. Abreu, a professor of medicine and chief of gastroenterology at the University of Miami Miller School of Medicine, told HealthDay. "A lot of people were going to get better no matter what you did."

People with abdominal discomfort who don't get better even with proton pump inhibitors, she said, "merit further investigation to make sure they don't have some significant pathology."

Indigestion, which can occur occasionally or as often as every day, is common in adults, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. A number of possible causes exist, including gastroesophageal reflux disease, peptic ulcer disease, cancer and abnormalities in the pancreas or bile ducts. Symptoms of indigestion usually improve if the underlying condition improves or is resolved.

Indigestion for which no cause can be found is called functional dyspepsia and is believed to occur where the stomach meets the small intestine. This type of indigestion can be caused by abnormal squeezing or relaxation of the stomach as it receives, digests and transfers food into the small intestine.

On the Web

To learn more about indigestion, visit the American Academy of Family Physicians.

SOURCES: HealthDay News; Robert Laheij, M.D., Ph.D., Department of Gastroenterology, Radboud University Nijmegen Medical Center, the Netherlands; Maria T. Abreu, M.D., professor of medicine and chief, Division of Gastroenterology, University of Miami Miller School of Medicine, Miami; Jan. 17, 2009, The Lancet; U.S. National Institute of Diabetes and Digestive and Kidney Diseases (
Author: Robert Preidt
Publication Date: Jan. 31, 2010
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