Yogesh Garje

Acid peptic disease (APD) is often associated with comorbidities. Choosing a proton pump inhibitor (PPI) is critical in such patients, given the frequent use of multiple concomitant medications in routine clinical practice. This real-world study was planned in India to understand drug utilization and prescription patterns of PPIs in APD patients with comorbidities. The aim was to evaluate the real-world drug utilization patterns of PPIs and to explore the adherence, effectiveness, and tolerability of pantoprazole in APD patients with comorbidities in India. This multicenter, retrospective, electronic medical record-based study analyzed data of adult APD patients with comorbidities treated with PPIs at four Indian outpatient clinics (January 2017-December 2020). Patients aged ≥18 years with at least two follow-up visits were included, and outcomes assessed included utilization patterns, adherence, effectiveness, and tolerability. The study included data from 687 patients with APD, who had a mean age of 47.8 years, and 56.6% of them were male. Patients had various comorbidities, and PPIs were co-prescribed with antidiabetics, antiplatelets, antihypertensives, antibiotics, and antithyroid drugs. Pantoprazole was the most commonly prescribed PPI (51.7%), followed by esomeprazole (20.2%), rabeprazole (13.0%), lansoprazole (9.2%), and omeprazole (6.0%). A greater proportion of patients treated with pantoprazole adhered to treatment when compared to other PPIs at follow-up visits. All APD symptoms significantly reduced at follow-up visit 2 compared to baseline across all PPIs (p < 0.05). All PPIs were well-tolerated, with adverse events consistent with their known profiles. This real-world study highlighted utilization patterns of PPIs and demonstrated that all PPIs are effective and well-tolerated in managing APD symptoms in patients with comorbidities. Pantoprazole was the most co-prescribed and preferred PPI amongst the prescribed PPIs. These findings provide real-world insights into how PPIs are utilized in Indian patients with APD and comorbidities and may help clinicians make informed decisions when selecting an appropriate PPI in routine practice. The study was registered in the Clinical Trial Registry of India (CTRI number: CTRI/2021/06/034237).

Background: Nonalcoholic fatty liver disease (NAFLD) and its progressive form, nonalcoholic steatohepatitis (NASH), represent an increasing clinical and public health burden in India. Despite their high prevalence, there are limited data on their diagnostic and management approaches among Indian health care providers. Real-world evidence on how Indian gastroenterologists and hepatologists diagnose and manage these conditions remains limited. Objective: This study aimed to understand the current disease perspectives, diagnostic modalities, and management practices for NAFLD and NASH among Indian hepatologists and gastroenterologists. Methods: A nationwide, web-based cross-sectional survey was conducted online between May 2023 and July 2023 among practicing gastroenterologists and hepatologists from health care setups, clinics, and hospitals located across India. The structured, self-administered questionnaire included 34 items covering 3 domains: disease perspectives (n=16), diagnostic modalities (n=4), and management strategies (n=14). Descriptive statistics were used to summarize responses as counts and percentages. Results: A total of 609 physicians completed the online survey (gastroenterologists: n=556, 91.3%; hepatologists: n=53, 8.7%). For 336 (55.2%) physicians, NAFLD accounted for 25% to 50% of the patients consulted per month, and 220 (36.1%) physicians reported that 10% to 20% of patients with NAFLD had NASH. Obesity (n=583, 95.7%) and diabetes (n=579, 95.1%) were cited as leading risk factors for NAFLD. Transient elastography was the diagnostic tool preferred by 558 (91.6%) physicians, followed by NAFLD fibrosis score (n=378, 62.1%) and Fibrosis-4 score (n=356, 58.5%); only 154 (25.3%) physicians used liver biopsy. For treatment, 414 (68%) physicians managed patients using pharmacotherapy and dietary and lifestyle modifications, while 195 (32%) relied on lifestyle modification alone. Antioxidant vitamins (n=543, 89.2%) and saroglitazar (n=522, 85.7%) were the most frequently prescribed therapies. The main barriers to optimal NASH management reported were lack of patient awareness (n=466, 76.5%) and limited availability of effective pharmacological options (n=303, 49.8%). Conclusions: This large, nationwide survey highlights that NAFLD and NASH constitute a major part of gastroenterology and hepatology practice in India. Although transient elastography and pharmacological agents such as saroglitazar and vitamin E are widely used, considerable heterogeneity exists in diagnostic and management approaches. The lack of patient awareness and effective treatment options remain the major hurdles in managing NAFLD and NASH. These findings underscore the need for the wider implementation of existing India-specific consensus recommendations, continued physician education, and future research focusing on tailored interventions in the management of NAFLD and NASH for the Indian population.

BACKGROUND Nonalcoholic fatty liver disease (NAFLD) and its progressive form, nonalcoholic steatohepatitis (NASH), represent an increasing clinical and public health burden in India. Despite their high prevalence, there are limited data on their diagnostic and management approaches among Indian health care providers. Real-world evidence on how Indian gastroenterologists and hepatologists diagnose and manage these conditions remains limited. OBJECTIVE This study aimed to understand the current disease perspectives, diagnostic modalities, and management practices for NAFLD and NASH among Indian hepatologists and gastroenterologists. METHODS A nationwide, web-based cross-sectional survey was conducted online between May 2023 and July 2023 among practicing gastroenterologists and hepatologists from health care setups, clinics, and hospitals located across India. The structured, self-administered questionnaire included 34 items covering 3 domains: disease perspectives (n=16), diagnostic modalities (n=4), and management strategies (n=14). Descriptive statistics were used to summarize responses as counts and percentages. RESULTS A total of 609 physicians completed the online survey (gastroenterologists: n=556, 91.3%; hepatologists: n=53, 8.7%). For 336 (55.2%) physicians, NAFLD accounted for 25% to 50% of the patients consulted per month, and 220 (36.1%) physicians reported that 10% to 20% of patients with NAFLD had NASH. Obesity (n=583, 95.7%) and diabetes (n=579, 95.1%) were cited as leading risk factors for NAFLD. Transient elastography was the diagnostic tool preferred by 558 (91.6%) physicians, followed by NAFLD fibrosis score (n=378, 62.1%) and Fibrosis-4 score (n=356, 58.5%); only 154 (25.3%) physicians used liver biopsy. For treatment, 414 (68%) physicians managed patients using pharmacotherapy and dietary and lifestyle modifications, while 195 (32%) relied on lifestyle modification alone. Antioxidant vitamins (n=543, 89.2%) and saroglitazar (n=522, 85.7%) were the most frequently prescribed therapies. The main barriers to optimal NASH management reported were lack of patient awareness (n=466, 76.5%) and limited availability of effective pharmacological options (n=303, 49.8%). CONCLUSIONS This large, nationwide survey highlights that NAFLD and NASH constitute a major part of gastroenterology and hepatology practice in India. Although transient elastography and pharmacological agents such as saroglitazar and vitamin E are widely used, considerable heterogeneity exists in diagnostic and management approaches. The lack of patient awareness and effective treatment options remain the major hurdles in managing NAFLD and NASH. These findings underscore the need for the wider implementation of existing India-specific consensus recommendations, continued physician education, and future research focusing on tailored interventions in the management of NAFLD and NASH for the Indian population.