Medication Risk-Taking Behavior in Functional Dyspepsia Patients

Abstract

Objectives:No medication is approved for the treatment of functional dyspepsia (FD). The risks that patients would be willing to take to cure their FD symptoms are unknown.Methods:FD patients (Rome III criteria) were mailed a questionnaire that assessed demographics, medication use, and prior medication adverse events. Scales to measure FD severity, quality of life, anxiety, depression, impulsiveness, and risk-taking behavior were included. A standard gamble (SG) evaluated willingness to take risks associated with a theoretical FD medication. Data were analyzed using simple descriptive statistics.Results:One hundred and fourteen responses were analyzed (54.5% response rate). The mean age of the patients was 49.2 years; 84% were women and 96% were white. The mean duration of symptoms was 8.2 years (range 1–38 years). The most bothersome symptom was upper abdominal discomfort (25%), followed by upper abdominal pain (22%) and bloating (15%). Forty percent of respondents rated their FD symptoms as moderate and 31% as mild. Forty-six percent reported a side effect from a prescription medication used to treat FD. When asked about a hypothetical medication that could cure their FD symptoms, 49% of respondents reported that they would accept a mean 12.7% risk of sudden death for a 99% chance of cure.Conclusions:This prospective study suggests that FD patients are surprisingly willing to take significant risks with a hypothetical medication to cure their symptoms. To counsel patients effectively and assist in the development of informed, preference-based decisions regarding medication therapy, physicians need to elicit and understand FD patients' risk adversity.

Functional Dyspepsia

“…Given the limited efficacy of the majority of conventional medical therapies, it is not surprising that up to 50% of patients with functional dyspepsia seek out other forms of treatment 71 ; in one study, nearly 50% of the patients were willing to accept a 12.7% risk of sudden death with a drug that offered a 99% chance of cure, 72 in the hope of improving their symptoms and quality of life. However, consistent evidence of the efficacy of acupuncture, homeopathy, or probiotics in functional dyspepsia is lacking.…”

The willingness of patients with gastroparesis to take risks with medications

“…These novel results extend recent findings that patients with chronic gastrointestinal disorders such as irritable bowel syndrome and functional dyspepsia consider their symptoms severe enough that they would be willing to exchange a longer lifespan for better health and quality of life. For example, patients with irritable bowel syndrome reported that they would accept a median 1% risk of sudden death for a 99% chance of cure of their irritable bowel syndrome symptoms, while patients with functional dyspepsia were willing to accept a 12.7% risk of sudden death for a chance to cure their symptoms . Crohn's disease patients have indicated that they are willing to accept increased serious adverse event risks in exchange for clinical efficacy …”

“…For example, patients with irritable bowel syndrome reported that they would accept a median 1% risk of sudden death for a 99% chance of cure of their irritable bowel syndrome symptoms, 18 while patients with functional dyspepsia were willing to accept a 12.7% risk of sudden death for a chance to cure their symptoms. 19 Crohn's disease patients have indicated that they are willing to accept increased serious adverse event risks in exchange for clinical efficacy. 17 Our hypothesis was confirmed with a significant association between symptom severity and medication risk acceptance.…”

“…In the late 1980’s and early 1990’s researchers used a standard gamble to assess the willingness of patients to accept associated risks in the treatment of rheumatic disease and arthritis . These studies have more recently extended into chronic gastrointestinal disorders including irritable bowel syndrome, functional dyspepsia and Crohn's disease . Gastroparesis patients’ willingness to accept risks associated with the use of medications intended to treat their chronic symptoms has not been studied.…”

“…15,16 These studies have more recently extended into chronic gastrointestinal disorders including irritable bowel syndrome, functional dyspepsia and Crohn's disease. [17][18][19] Gastroparesis patients' willingness to accept risks associated with the use of medications intended to treat their chronic symptoms has not been studied.…”