A cross-sectional study of national outpatient gastric acid suppressant prescribing in the United States between 2009 and 2015

Abstract

PurposeGastric acid suppressants are commonly used in the United States, and while generally well-tolerated, long-term use has been associated with infection, bone fractures, and nutrient malabsorption. The purpose of this study was to describe national trends in gastric acid suppressant use over a 7-year period.MethodsThis was a cross-sectional study using data from the National Ambulatory Medical Care Survey from 2009 to 2015. Gastric acid suppressant use was defined as any outpatient visit with a documented prescription for a proton pump inhibitor or histamine-2 receptor antagonist documented during the outpatient visit. Sample data weights were used to extrapolate to national estimates. Use was calculated as the number of prescriptions per total outpatient visits per year. Appropriateness of prescribing was assessed using FDA-approved indications listed in each visit.ResultsThese data represent 6.8 billion patient outpatient visits between 2009 and 2015, of which nearly 600 million (8.8%) had documented gastric acid suppressant use. The median (IQR) age of gastric acid suppressant users and non-gastric acid suppressant users was 62 (50–73) and 49 (25–65), respectively. Gastric acid suppressant use decreased from 9.0% in 2009 to 7.7% in 2012, and then increased to 9.7% in 2015. Proton pump inhibitor use was slightly higher in the Midwest (8.3%). Only 15.8% of gastric acid suppressant users had a documented indication.ConclusionsProton pump inhibitor use increased after 2012, and the majority of gastric acid suppressant users did not have a documented indication. Judicious gastric acid suppressant prescribing needs to be exercised, especially in the context of new safety data regarding long-term proton pump inhibitor use.

A Novel Approach to Visualize Risk Minimization Effectiveness: Peeping at the 2012 UK Proton Pump Inhibitor Label Change Using a Rapid Cycle Analysis Tool

“…Our descriptive findings compare to other research that has evaluated PPI prescription patterns and demographics in the UK and elsewhere. For example, we found the proportion of female users was 54.8-56.5%, which is very similar to the 55.9% described in a UK Clinical Practice Research Database (CPRD) study [27], the 55.0% in a regional study of elderly Swedes [28], and the 60.3% found in a recent US study of gastric acid suppressant prescribing in the US [29].…”

A Randomized Open-Label Study of Two Methods of Proton Pump Inhibitors Discontinuation

“…Many patients, unfortunately, take PPIs for minor symptoms and become long-term users without clear indication. In fact, Bustillos et al reported that of approximately 600 million documented PPI and histamine blocker (H2 blocker) users, only 15.8% had documentation of an appropriate indication such as heartburn, dyspepsia, gastrointestinal ulcer, erosive esophagitis, GERD, Helicobacter pylori , Zollinger-Ellison syndrome, or long-term non-steroidal anti-inflammatory drug (NSAID) use [ 4 ]. Taking PPIs without clear indication or for longer periods of time than necessary is problematic because long-term use is associated with increased risk of nutritional deficiencies (vitamin B12, magnesium, iron), osteoporosis, Clostridioides difficile infections, pneumonia, and possibly acute and chronic kidney disease [ 1 ].…”

Trends and patterns of neurotology drug prescriptions on a nationwide insurance database

“… 3 These regional differences have also been reported in other classes of drugs, as greater quantities of oral antibiotics and proton pump inhibitors have been prescribed to residents in the Midwest or Southern U.S. states. 19 , 20 , 21 These data signal that the volume and cost per capita of some medications, including those prescribed by neurotologists, may be more concentrated in Central and Southern U.S. regions, warranting further investigation into the possible rationale.…”