Survey-Based Analysis of Current Trends for Prescribing Gastrointestinal Protectants among Small-Animal General Practitioners in Portugal

Abstract

In both human and veterinary healthcare, gastrointestinal protectants (GIPs) are considered a staple of clinical practice in that they are prescribed by general practitioners (GPs) and specialists alike. Concerning GIP use, overprescription of proton pump inhibitors (PPIs) has become a growing concern among human healthcare providers. This trend has also been documented within veterinary practice, prompting the American College of Veterinary Internal Medicine (ACVIM) to publish a consensus statement in 2018 concerning evidence-based indications for GIP use. This observational cross-sectional study evaluated self-reported prescribing protocols among Portuguese GPs to determine whether there is adherence to the consensus guidelines. Respondents were Portuguese GPs recruited by social media posts in veterinarian online forums. Data were collected from 124 respondents concerning their GIPs of choice and their rationales for prescribing them. Data were mined for prescription patterns and protocols. Among GIPs, PPIs were prescribed more often. Rationales for use included gastrointestinal ulceration and erosion (GUE), prophylactic management of nonerosive gastritis, pancreatitis, reflux esophagitis, and steroid-induced ulceration. Once-daily administration of PPIs was the most frequent dosing regime among respondents. Ninety-six percent of PPI prescribers advocated that the drug be administered either shortly before or at mealtime. Forty-nine percent of respondents supported long-term use of PPIs. Fifty-nine percent of respondents acknowledged discontinuing PPIs abruptly. This study supports that Portuguese GPs commonly prescribe GIPs in accordance with ACVIM recommendations to medically manage GUE. However, misuse of GIPs does occur, and they have been prescribed where their therapeutic value is debatable. Educational strategies should target GPs in an effort to reduce GIP misuse.

Evaluation of proton pump inhibitor administration in hospitalized dogs in a tertiary referral hospital

“…Despite these studies, inappropriate use of these medications is as likely or more common than observed in human medicine. For example, in a recent survey of small animal general practitioners in Portugal, 98.3% had prescribed a PPI without an appropriate indication for use 16 …”

“…For example, in a recent survey of small animal general practitioners in Portugal, 98.3% had prescribed a PPI without an appropriate indication for use. 16 Gastric acid secretion is a normal physiologic mechanism that contributes to appropriate digestion of protein, release of cobalamin, absorption of inorganic iron 17 and calcium, 18 and regulation of the intestinal microbiome by suppression of bacterial overgrowth. 19 The stomach has natural protective mechanisms to prevent against gastric erosion and ulceration as a result of gastric acid secretion and therefore acid suppression generally is not recommended in the absence of erosive or infiltrative disease.…”

Evaluation of a long‐acting injectable formulation of omeprazole in healthy dogs

“… 16 The PPIs and other gastroprotectants are often used inappropriately and overprescribed by general practitioners and veterinary specialists. 17 , 18 , 19 The authors advise judicious use of this medication for dogs where severe GI bleeding, treatment compliance, or both is a concern.…”

“…Although these potential benefits still need to be investigated in clinical cases, it is important to note that LA‐OMEP should only be used in dogs with a clear indication for gastric acid suppression, utilizing the guidelines established by the American College of Veterinary Internal Medicine Consensus Statement on the rational use of gastroprotectants 16 . The PPIs and other gastroprotectants are often used inappropriately and overprescribed by general practitioners and veterinary specialists 17‐19 . The authors advise judicious use of this medication for dogs where severe GI bleeding, treatment compliance, or both is a concern.…”

Evaluation of gastroprotectant administration in hospitalized cats in a tertiary referral hospital

“…Gastroprotectant medications, particularly acid suppressants such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), are widely prescribed in human and small animal veterinary medicine to prevent and treat acid-related esophageal and gastrointestinal (GI) mucosal injury. [1][2][3][4][5][6][7][8][9][10] Frequent use in humans and animals has led to growing concerns of overutilization and inappropriate prescriptions of gastroprotectants. 1,[7][8][9][10][11][12][13][14] In humans, excessive acid suppressant prescription 1,[14][15][16] has resulted in an excess expenditure on PPIs of nearly $10 billion per year in the USA 17 and increased recognition of adverse effects associated with chronic, prolonged use of PPIs, such as micronutrient deficiencies, small intestinal bacterial overgrowth, pneumonia, osteoporosis, dementia and chronic renal insufficiency.…”