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Anecdotal reports and studies of select populations suggest that the use of proton pump inhibitors (PPIs) has increased since their introduction. We sought to determine recent trends in PPI use in the U.S. outpatient setting and characteristics of patients and physicians that may predict their use.
We used data from the National Ambulatory Medical...
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Background/Aims: Despite the efficacy of proton pump inhibitor (PPI) treatment, a considerable number of patients with non-erosive reflux disease (NERD) are resistant to treatment with a PPI at the standard dose. In these patients, doubling the dose of PPI is one of the potential therapeutic strategies. However, only few studies support this therap...
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![Figure 3. The Stern-Volmer plot for the binding of OMEHSA at 286[ ],...](profile/Suma-Pawar/publication/309416859/figure/fig7/AS:668879885959190@1536484800900/The-Stern-Volmer-plot-for-the-binding-of-OMEHSA-at-286-293-300-N-and-307-K_Q320.jpg)
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Citations
... Long-term use is also applied as a preventive strategy to reduce the risk of peptic ulceration and gastrointestinal bleeding in the context of non-steroidal anti-inflammatory drugs and low-dose aspirin use. 1,2 Although Helicobacter pylori eradication decreases the risk of peptic ulceration, eradication success augments gastric acid secretion, and this may be associated with the occurrence of GERD. In Japan, the prevalence of H. pylori infection is decreasing, and this has been associated with a decrease in the prevalence of gastric atrophy. ...
Gastric mucosal changes associated with long‐term potassium‐competitive acid blocker and proton pump inhibitor (PPI) therapy may raise concern. In contrast to that for PPIs, the evidence concerning the safety of long‐term potassium‐competitive acid blocker use is scant. Vonoprazan (VPZ) is a representative potassium‐competitive acid blocker released in Japan in 2015. In order to shed some comparative light regarding the outcomes of gastric mucosal lesions associated with a long‐term acid blockade, we have reviewed six representative gastric mucosal lesions: fundic gland polyps, gastric hyperplastic polyps, multiple white and flat elevated lesions, cobblestone‐like gastric mucosal changes, gastric black spots, and stardust gastric mucosal changes. For these mucosal lesions, we have evaluated the association with the type of acid blockade, patient gender, Helicobacter pylori infection status, the degree of gastric atrophy, and serum gastrin levels. There is no concrete evidence to support a significant relationship between VPZ/PPI use and the development of neuroendocrine tumors. Current data also shows that the risk of gastric mucosal changes is similar for long‐term VPZ and PPI use. Serum hypergastrinemia is not correlated with the development of some gastric mucosal lesions. Therefore, serum gastrin level is unhelpful for risk estimation and for decision‐making relating to the cessation of these drugs in routine clinical practice. Given the confounding potential neoplastic risk relating to H. pylori infection, this should be eradicated before VPZ/PPI therapy is commenced. The evidence to date does not support the cessation of clinically appropriate VPZ/PPI therapy solely because of the presence of these associated gastric mucosal lesions.
... Proton-pump inhibitors (PPI) have seen a sharp rise in use, which has led to several inappropriate and increasing misuse cases (Yadlapati et al., 2017;Mohzari et al., 2020). While the number of reported PPI uses increased from 30 million to 84 million between 2002 and 2009, rising concerns have been raised due to the lack of documentation of gastrointestinal complaints or diagnoses in more than 60 % of these visits in the United States (Rotman and Bishop, 2013). There have been complaints of PPI overuse, and various investigations have shown that PPI is often used incorrectly (Nguyen and Tamaz, 2018;Kelly et al., 2015). ...
Background and objectives
The elderly population is affected by chronic diseases and lifelong medication. The American Geriatrics Society (AGS) Beers Criteria is a comprehensive approach to medication usage in the older population to reduce potentially inappropriate medication (PIM) use. The purpose of this study was to assess the usage of PIMs in elderly patients upon discharge from tertiary care hospital settings in Riyadh, Saudi Arabia, using the AGS Beers Criteria 2019.
Methods
The data was obtained from the medical records of 1237 patients (>65 years) who were discharged from medical or surgical wards at two hospitals affiliated with King Abdulaziz Medical City. The data was analyzed to determine the prevalence of PIM prescription, and the proportional odds of the independent factors influencing outcomes were estimated using ordinal regression analysis for criteria 1 and 2, while Binary regression analysis was conducted for criterion 3.
Results
There were approximately equal numbers of male and female participants in our study (male: 50.8 % vs. female: 49.2 %). One-third of the patients were above the age of 80 years, with 41 % being between the ages of 70 and 80 years. Moreover, almost 70 % of the samples had chronic illnesses. The overall prevalence of PIMs was 29.2 %, with 11 % of PIMs to be avoided in elderly patients and 17 % to be used with caution in the elderly, while disease-specific PIMs were identified in 1.2 % of the patients. The most common PIM class was proton pump inhibitors (44.41 %), and patients discharged from the surgical unit were more likely to be prescribed PIMs. Proton pump inhibitors (44.41 %) were the most inappropriately prescribed drug class, and patients discharged from the surgical unit were more likely to be prescribed PIMs.
Conclusion
The study noticed that male gender, the presence of multiple diseases, and obesity are associated with more than one PIM prescription. There is a need to streamline the surgical department’s prescription procedure to eliminate prescription disparities. Prescription monitoring is recommended to avoid medication errors, particularly in patients who are taking multiple medications.
... Proton-pump inhibitors (PPIs) are frequently prescribed medications in the ambulatory care setting (8%-10% of all prescriptions). 1,2 The Canadian Association of Gastroenterology recommends that chronic PPI use (defined as >8 weeks) be limited to patients with specific indications including prior gastrointestinal bleed (GIB) or concurrent non-steroidal anti-inflammatory drug (NSAID) use. 3 Choosing Wisely Canada suggests discontinuation of PPI should be trialed at least once per year due to concerns of adverse events. [3][4][5] As with the general population, long-term PPI use in kidney transplant recipients has been linked to complications, such as hip fractures, kidney dysfunction, and mortality. ...
... 26,27 This likely reflects the degree of comorbidity in transplant recipients as only 8%-10% of the general population are prescribed PPIs. 1 The recipients in the PPI group were more likely to have cardiac and vascular comorbidities compared with the recipients in the H2Ra and neither groups. This may explain why the most common indication was concurrent antiplatelet prescription. ...
Background
Kidney transplant recipients are commonly prescribed proton-pump inhibitors (PPIs), but due to concern for polypharmacy, chronic use should be limited.
Objective
The objective was to describe PPI use in kidney transplant recipients beyond their first year of transplant to better inform and support deprescribing initiatives.
Design
We conducted a retrospective, population-based cohort study using linked health care databases.
Setting
This study was conducted in Alberta, Canada.
Patients
We included all prevalent adult, kidney-only transplant recipients between April 2008 and December 2017 who received their transplant between May 2002 and December 2017.
Measurements
The primary outcome was ongoing or new PPI use and patterns of use, including frequency and duration of therapy, and assessment of indication for PPI use.
Methods
We ascertained baseline characteristics, covariate information, and outcome data from the Alberta Kidney Disease Network (AKDN). We compared recipients with evidence of a PPI prescription in the 3 months prior to study entry to those with a histamine-2-receptor antagonist (H2Ra) fill and those with neither.
Results
We identified 1823 kidney transplant recipients, of whom 868 (48%) were on a PPI, 215 (12%) were on an H2Ra, and 740 (41%) were on neither at baseline. Over a median follow-up of 5.4 years (interquartile range [IQR] = 2.6-9.3), there were almost 45 000 unique PPI prescriptions dispensed, the majority (80%) of which were filled by initial PPI users. Recipients who were on a PPI at baseline would spend 91% (IQR = 70-98) of their graft survival time on a PPI in follow-up, and nephrologists were the main prescribers. We identified an indication for ongoing PPI use in 54% of recipients with the most common indication being concurrent antiplatelet use (26%).
Limitations
Our kidney transplant recipients have access to universal health care coverage which may limit generalizability. We identified common gastrointestinal indications for PPI use but did not include rare conditions due to concerns about the validity of diagnostic codes. In addition, symptoms suggestive of reflux may not be well coded as the focus of follow-up visits is more likely to focus on kidney transplant.
Conclusions
Many kidney transplant recipients are prescribed a PPI at, or beyond, the 1-year post-transplant date and are likely to stay on a PPI in follow-up. Almost half of the recipients in our study did not have an identifiable indication for ongoing PPI use. Nephrologists frequently prescribe PPIs to kidney transplant recipients and should be involved in deprescribing initiatives to reduce polypharmacy.
... 29 When medications have been used for many years, there may be diffusion or loss of responsibility to evaluate their continued benefit and deprescribe as indicated. 30 The involvement of a patient's care partners, while typically beneficial, can increase interpersonal complexity. Patients may depend on multiple care partners to F I G U R E 1 Description of the factors that contribute to having multiple prescribers and that can influence the successful implementation of a deprescribing intervention at the different levels of the socioecological model. ...
Deprescribing is the intentional dose reduction or discontinuation of a medication. The development of deprescribing interventions should take into consideration important organizational, interprofessional, and patient‐specific barriers that can be further complicated by the presence of multiple prescribers involved in a patient's care. Patients who receive care from an increasing number of prescribers may experience disruptions in the timely transfer of relevant healthcare information, increasing the risk of exposure to drug–drug interactions and other medication‐related problems. Furthermore, the fragmentation of healthcare information across health systems can contribute to the refilling of discontinued medications, reducing the effectiveness of deprescribing interventions. Thus, deprescribing interventions must carefully consider the unique characteristics of patients and their prescribers to ensure interventions are successfully implemented. In this special article, an international working group of physicians, pharmacists, nurses, epidemiologists, and researchers from the United States Deprescribing Research Network (USDeN) developed a socioecological model to understand how multiple prescribers may influence the implementation of a deprescribing intervention at the individual, interpersonal, organizational, and societal level. This manuscript also includes a description of the concept of multiple prescribers and outlines a research agenda for future investigations to consider. The information contained in this manuscript should be used as a framework for future deprescribing interventions to carefully consider how multiple prescribers can influence the successful implementation of the service and ensure the intervention is as effective as possible.
... It has also been suggested that modern hygienic practices in childhood may have played a part in the observed increase in EoE incidence due to less exposure to microbes, which subsequently leads to increased sensitivity to microbes/allergens in adulthood [25]. The increased use of proton pump inhibitors over the years has also been suggested to have a role in the increased EoE incidence mainly due to its acidsuppressing effect by reducing peptic digestion of food allergens and microbes increasing exposure of these allergens/microbes to the gastrointestinal mucosa [18,26,27]. Overall, there is evidence supporting the pathogenic role of allergens, but the exact role of these environmental allergens remains unclear in the etiopathogenesis of EoE. ...
Background
Eosinophilic esophagitis (EoE) is a chronic antigen-mediated esophageal disease characterized by infiltration of the esophageal mucosa by eosinophils. The prevalence of EoE continues to rise worldwide. However, certain aspects of the epidemiology and pathogenesis remain unclear.
Methods
This study examined the hospitalization trends of EoE using an extensive inpatient database in the United States, the National (Nationwide) Inpatient Sample (NIS), to identify hospitalizations between 2010 and 2019. We assessed patient demographics as well as hospital-specific variables using the NIS. We obtained the prevalence rate of EoE for each year and used joinpoint regression analysis to obtain trends after adjusting the rate for age and gender. We also sought to characterize the outcomes of these hospitalizations by obtaining the mortality rate, length of stay (LOS), and total hospital charges (THC).
Results
Of 305 million hospitalizations included in the study, 33,878 were for EoE. The prevalence rate per 100,000 hospitalizations of EoE increased from 6.6 in 2010 to 15.5 in 2019. The annual percentage change obtained from the joinpoint regression analysis was 13.3% from 2010 to 2014 and 7.2% from 2014 to 2019. Most of the hospitalizations were among the male gender and young adults. Almost 95% of hospitalizations across the study period were seen in urban hospitals. We did not notice any significant trend in the mortality rates or length of stay over the study period. The THC increased significantly across the study period.
Conclusion
There has been an upward trend in the average prevalence rate of EoE over the decade from 2010 to 2019 which almost parallels that of inflammatory bowel disease. This represents a significant burden of disease for a condition that was initially recognized in the late 20th century.
... Studies have shown that patients are often prescribed PPIs for inappropriate indications or are administered high doses of PPIs for extended periods, contrary to clinical guidelines. Additionally, it has been reported that patients are discharged from hospitals with PPIs that are not indicated for their condition [2][3][4][5]. Although PPIs are generally deemed safe, concerns and evidence of potential long-term complications of PPIs therapy are increasingly emerging. ...
Purpose
Despite the generally considered safety of proton pump inhibitors (PPIs), growing evidence and concerns have raised questions about their potential long-term complications. This study aimed to investigate the association between PPIs therapy and the prevalence of hepatic steatosis and liver fibrosis in the outpatient population of the United States.
Methods
The study included 7,395 individuals aged 20 years and older who underwent hepatic vibration-controlled transient elastography (VCTE) examinations. Data were obtained from the 2017 and March 2020 pre-pandemic National Health and Nutrition Examination Survey.
Results
Among the 7,395 adults included in this study (mean age, 50.59 years; 3,656 males), 9.8% had a prescription for PPIs. After multivariable adjustment, the use of PPIs was significantly associated with hepatic steatosis (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02–1.53). Prolonged use of PPIs was found to increase the risk of developing hepatic steatosis over time (p for trend = 0.006). Sensitivity analyses using different definitions of hepatic steatosis, such as controlled attenuation parameter ≥ 285 dB/m (OR, 1.19; 95% CI, 1.01–1.40), nonalcoholic fatty liver disease (OR, 1.50; 95% CI, 1.16–1.93), and metabolic dysfunction associated steatotic liver disease (OR, 1.26; 95% CI, 1.05–1.52), consistently showed an association between PPIs prescription and hepatic steatosis.
Conclusion
The administration of PPIs therapy has been found to be linked with heightened hepatic steatosis in US adults, although no significant correlation was observed with liver stiffness, as determined by VCTE.
... PPIs were dispensed over 115 million times in 2016. 6 Additionally, up to 63% of PPI prescriptions did not have a documented gastrointestinal diagnosis and may have been inappropriately prescribed 5,7 . Long-term use of PPIs has not been approved; nevertheless, chronic PPI use is common 8 . ...
Background
Studies on the association between proton pump inhibitor (PPI) use and dementia report mixed results and do not examine the impact of cumulative PPI use. We evaluated the associations between current and cumulative PPI use and risk of incident dementia in the Atherosclerosis Risk in Communities (ARIC) Study.
Methods
These analyses used participants from a community-based cohort (ARIC) from the time of enrollment (1987-89) through 2017. PPI use was assessed via visual medication inventory at clinic Visits 1 (1987-89) to 5 (2011-13) and reported annually in study phone calls (2006-2011). The present study uses ARIC Visit 5 as baseline, since this was the first visit in which PPI use was common. PPI use was examined two ways: current use at Visit 5 and duration of use prior to Visit 5 (Visit 1 to 2011, exposure categories: 0 days, 1 day – 2.8yrs, 2.8-4.4yrs, >4.4yrs). The outcome was incident dementia after visit 5. Cox Proportional Hazard models were used, adjusted for demographics, co-morbid conditions, and other medication use.
Results
A total of 5,712 dementia-free participants at visit 5 (mean age 75.4±5.1 years; 22% Black race; 58% female) were included in our analysis. The median follow-up was 5.5 years. Minimum cumulative PPI use was 112 days and maximum use was 20.3 years. There were 585 cases of incident dementia over median follow up time. Participants using PPIs at Visit 5 were not at a significantly higher risk of developing dementia during subsequent follow-up than those not using PPIs (Hazard Ratio (HR): 1.1 [95% Confidence Interval (CI): 0.9-1.3]). Those who used PPIs for >4.4 cumulative years prior to Visit 5 were at 33% higher risk of developing dementia during follow-up (HR: 1.3 [95%CI: 1.0-1.8]) than those reporting no use. Associations were not significant for lesser amounts of PPI use.
Discussion
Future studies are needed to understand possible pathways between cumulative PPI use and the development of dementia.
Classification of Evidence
This study provides Class III evidence that use of prescribed PPIs for > 4.4 years by individuals ages 45 years and older is associated with a higher incidence of newly diagnosed dementia.
... 25,26 Nýgengi PPH-notkunar í kjölfar skurðaðgerða fór haekkandi á tímabilinu, sem er í samraemi við fjölgun ávísana um 47% á tímabilinu og aukningu í sölu lausasölulyfja á sama tímabili en einnig niðurstöður íslenskrar rannsóknar sem sýndi haekkun í nýgengi notkunar PPH á tímabilinu 2003-2015. 1,13,27 Notkun PPH fór ekki stigvaxandi með haekkandi aldri sjúklinga í þessari rannsókn, en fyrri rannsóknir hafa sýnt Ofur-fjöllyfjameðferð (≥10 lyf) 6159 (15,5) 776 (26,9) Tafla II. Lýsandi eiginleikar þeirra sjúklinga sem hófu notkun PPH í kjölfar skurðaðgerða á árunum 2006-2018, flokkað eftir langvinnri notkun lengur en í þrjá mánuði. ...
Introduction:
The use of proton pump inhibitors (PPI) has increased over the past decades. Some patients use the medication without an indication. It is possible that new use will start following surgery. The study aimed to examine the incidence of postoperative use of PPI following surgeries and the ratio of new persistent users over three months postoperatively as well as patient- and procedural variables associated with new use and new persistent use.
Methods:
Data of surgeries among adults that had undergone surgeries at the National University Hospital of Iceland from 2006 to 2018. The data were from the Icelandic perioperative database, containing information regarding medication usage preceding and following surgeries. The ratio of those who started using PPI within three months of surgery was assessed, and the ratio of persistent users.
Results:
Altogether, 2886 out of 42.530 patients filled PPI prescription within three months after their first surgery. Annual incidence was 67 per 1.000 surgeries, and the ratio of persistent users was 54%, although both the varied between years. The use was more common among women, highest in age group 56-65 years old, patients with polypharmacy (5-9 medicines) and who underwent abdominal surgeries.
Conclusions:
New postoperative PPI use is common following surgery and half of the patients with new use develop new persistent use. The usage increased similar to the increased number of prescriptions and sales of PPI in other patient groups during the period. The results indicate the need for further monitoring of patients with PPI prescriptions following surgeries in Iceland.
... Further, common co-medication within the target patient population should be respected during the development process. For example, proton pump inhibitors are widely used in older adults and at the same time it is known that they are influencing the bioavailability of multiple APIs (Ogawa and Echizen 2010;Rotman and Bishop 2013). By adjusting the formulation composition, the effect of increased pH due to co-administered proton pump inhibitors can be reduced. ...
Older adults are the main users of medicine and due to their multimorbidity are often faced/confronted with a complex medication management. This review article provides a brief overview on aspects of medication management such as maintaining a stock of the required medicine, understanding and following the instructions for use, coping with the primary and secondary packaging as well as preparation prior to use. The main focus however is on the drug intake itself and provides an overview about the current understanding of real life dosing conditions of older adults and geriatric patients. Furthermore, it elaborates the acceptability of dosage forms, in particular solid oral dosage forms as they represent the majority of dosage forms taken by these patient populations. An improved understanding of the needs of older adults and geriatric patients, their acceptability of various dosage forms and the circumstances under which they manage their medications, will make the design of more patient-centric drug products possible.
... they are also widely used in the treatment of general dyspeptic symptoms and in patients with functional dyspepsia and more recently in eosinophilic esophagitis [7][8][9]. PPis remain one of the most used medications in the outpatient setting, and data from surveys in the united States (uS) outpatient setting show that approximately 8-10% of all ambulatory adults have been prescribed a PPi within the last thirty days [10,11]. they are overall safe medications; however, in recent literature, there have been multiple associations between PPi use and adverse events such as risks of Clostridioides difficile infections, vitamin B12 deficiency, small intestinal bacterial overgrowth, kidney dysfunction, and bacterial enteritis in the general population [12][13][14]. ...
Objective
Proton pump inhibitor (PPI) use has been associated with reduced diversity of the gut microbiome and may lead to worse clinical outcomes in inflammatory bowel disease (IBD). We aimed to evaluate whether PPI use affects clinical outcomes in a real-world setting.
Design
Healthcare claims data of adult IBD patients were obtained from the IBM MarketScan Database. Multivariable analysis and propensity score-matched analysis were performed to assess associations between PPI use and new biologic start, and IBD-related hospitalizations and surgeries.
Results
A total of 46,234 IBD patients were identified (6,488 (14%) and 39,746 (86%) patients with and without PPI, respectively). Patients on PPI were more likely to be older, female, and smokers and less likely to be on immunomodulators. Multivariable analyses demonstrated that PPI use was associated with new biologic start (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.04–1.18), and IBD-related admissions (OR 1.95, 95% CI 1.74–2.19) and surgeries (OR 1.46, 95% CI 1.26–1.71). Following propensity score matching, patients on PPI remained more likely to start a new biologic (23% vs 21%, p = 0.011), and have IBD-related admissions (8% vs 4%, p < 0.001) and surgeries (4% vs 2%, p < 0.001). Subgroup analyses stratified by age, smoking, and glucocorticoid use showed similar results. There was a dose-response relationship between the number of PPI prescriptions and the risk of new biologic use (p < 0.001) and IBD-related admissions (p < 0.001).
Conclusion
PPI use was associated with worse clinical outcomes in patients with IBD in the real-world setting. Further studies are warranted to validate these findings, but caution may be needed when prescribing a PPI to IBD patients.
Study highlights WHAT IS KNOWN
Proton pump inhibitors (PPIs) are one of the most prescribed therapies in the United States (US).
Reduction of gastric acid secretion by PPI use increases the risk of imbalance in gut microbiota composition and may increase the risk of enteric infections.
Recent studies have reported that the use of PPI was associated with development of inflammatory bowel disease (IBD) and reduced rates of remission in patients on infliximab therapy, which may be due to alterations of intestinal microbiota.
WHAT IS NEW HERE
In a large real-world US healthcare database study, IBD patients with PPI use were more likely to have a new biologic medication started, have an IBD-related surgery, and have an IBD-related hospitalization, which remained significant after adjusting for confounders by multivariable analysis, propensity-score matched analysis, and subgroup analysis.
Appropriate clinical review of PPI necessity may need to be performed in patients with IBD when considering prescribing a PPI or who are already on PPI therapy.
