Inappropriate proton pump inhibitor use common

Inappropriate prescription of proton-pump inhibitors (PPIs) are common among gastroenterology outpatients, reflecting poor adherence to guidelines, a recent study has found.

The study included 249 patients (median age, 67 years; 61.4 percent female) who were consecutively referred to a gastroenterology outpatient clinic. PPI use details, including reasons for prescription, dose, modality, duration, and attempts at optimization, were recorded. Appropriateness was judged according to the 2018 position paper of the Italian Society of Gastroenterology.

The most common indication for PPI was gastro-oesophageal reflux disease (GORD; 57.4 percent), and the median duration of usage was 24 months. Sixty-eight patients (27.3 percent) reported being on PPI treatment for >60 months. Majority (63.1 percent; n=157) were on standard dosing regimens and reported continuous use of the drug (80.3 percent; n=200).

Pantoprazole saw use in 101 patients (40.6 percent) and emerged as the most commonly prescribed PPI, while rabeprazole was the least prescribed (n=19; 7.6 percent). General practitioners were responsible for majority of the prescriptions, while gastroenterology specialists were behind only 18.4 percent of PPI prescriptions.

PPI prescription was in line with guidelines in 61.4 percent (n=153) of the cases. General practitioners followed the guidelines in 59.9 percent of cases, gastroenterologists in 71.7 percent, and other specialists in 52.6 percent.

The use of PPIs for the treatment of dyspeptic symptoms saw a high rate of inappropriate prescription (83.3 percent), as did its concomitant use with anticoagulants (100 percent).

“[W]e feel that efforts to educate general practitioners and specialists to limit PPI prescription to appropriate indications and duration of treatment are promising and should be actively pursued,” researchers said.