Patient Adherence in the Treatment of Gastroesophageal Reflux Disease: Proton Pump Inhibitors Versus Histamine-2 Receptor Antagonists

Adherence to acid suppression therapy is essential in the management of gastroesophageal reflux disease (GERD). Current guidelines suggest that proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) are the mainstays of therapy. The likelihood of adherence to these medications and barriers that may affect adherence and persistence must be considered. A survey done by the Centers for Medicare and Medicaid Services suggests that barriers to adherence include complexity of therapeutic regimens, cost of therapy and lack of understanding of the purpose of treatment. Retrospective cohort studies have evaluated the rates of medication adherence and persistence to PPIs and have found overall rates to be low. When designing treatment regimens, clinicians often consider drug factors such as effectiveness, adverse effects and drug-drug interactions. However, barriers to adherence must also be considered by practitioners to ensure that maximum benefit of therapy can be achieved.