446 Do GI Patients Care About Adverse Effects of Proton Pump Inhibitors?

Abstract

INTRODUCTION: Proton Pump Inhibitors (PPIs) are generally considered to be safe. Recently, several observational studies have associated PPI use with potential adverse drug reactions (ADRs) including chronic kidney disease (CKD), dementia, and cardiovascular disease. Other potential ADRs such as osteoporotic fractures and increased risk of community acquired pneumonias and Clostridium difficile infection have been known for a longer period of time. Patient awareness of potential ADRs and its effect on continued use of PPIs have received little attention in the medical literature. AIM: To survey patients at a single community-setting outpatient endoscopy center to assess and understand gastrointestinal (GI) patient opinions about ADRs from PPI use. METHODS: An anonymous survey with 15 multiple choice questions regarding PPI use (two questions allowing for more than one answer) was distributed to all adult outpatient endoscopy patients at Advocate Lutheran General Hospital from January to March 2019. The survey questioned indication and duration of PPI use, awareness of PPI ADRs, level of concern for ADRs, and drug discontinuation. RESULTS: Of 2,288 patients surveyed, 1,689 (74%) returned the survey. Of these, 342 patients (20%) were current PPI users and were the subject of this analysis. The most common indications (multiple could be selected) for PPI usage were heartburn (n = 162), GERD (n = 155), and stomach/abdominal pain (n = 78) (Table 1). The most commonly identified ADRs related to PPI use were osteoporosis (n = 43) and CKD (n = 35) (Figure 1). However, 181 (53%) patients reported that they were not aware of any ADRs from PPIs. Of 218 (64%) patients who expressed concern regarding ADRs, 47 (14%) selected extreme concern, 57 (17%) with moderate concern, 88 (26%) somewhat concerned, and 26 (7%) hardly concerned (Figure 2). No concern was selected by 48 (14%), and 76 (22%) felt there were no ADRs from PPIs. There were 91 (27%) patients who attempted to stop their PPI treatment, but only 17 (5%) stopped because of concerns about ADRs. CONCLUSION: The majority of GI patients consuming PPIs are unaware of PPI-associated ADRs. However, when patients are alerted to these side effects, only approximately 60% of these patients express some degree of concern. More importantly, concern and awareness of these side effects does not appear to be a common cause for discontinuation for PPI therapy amongst GI patients.