The Right Idea for the Wrong Patient: Results of a National Survey on Stopping PPIs

Abstract

R ecent studies have linked proton pump inhibitor (PPI) use to serious adverse effects, including bone fracture, chronic kidney disease, dementia, and ischemic stroke. Although it remains unclear whether PPIs truly cause these adverse effects, this potential has forced physicians to carefully consider the safety and utility of long-term PPI use in their patients, a topic included in the American Board of Internal Medicine Foundation's Choosing Wisely campaign. 1 Using case vignettes, we sought to evaluate how internists' willingness to stop PPI varies according to drug indication.

Editorial: moving towards appropriate use of proton pump inhibitors. Authors’ reply

“…We thank Drs Kurlander and Rubenstein for their thoughtful comments on our article, which augments and supports many of the findings in their recent publications . We agree wholeheartedly that, while there are many potential adverse events associated with proton pump inhibitors (PPIs) and the drugs are (in some cases) prescribed for less than clear indications, the lay press—and, subsequently, patients and providers–have perhaps over‐reacted.…”

Editorial: moving towards the appropriate use of proton pump inhibitors

“…Furthermore, 60% of physicians had familiarity with PPI adverse effects, and 37% had changed their practice. These findings are in general agreement with other surveys on this topic, and highlight that concerns about adverse effects have drawn the attention of both parties. However, PPI indication was not a topic of either survey.…”

Internists’ Perceptions of Proton Pump Inhibitor Adverse Effects and Impact on Prescribing Practices: Results of a Nationwide Survey

“…However, it appears that these decisions are often discordant with best evidence. In an analysis of different data from the same survey, we found that when concerned about the possibility of an adverse effect, such as osteoporosis, physicians are more likely to recommend stopping PPIs in patients who use them for the prevention of aspirin-related upper GI bleeding versus GERD [ 21 ]. This surprising finding may represent a greater willingness on the part of physicians to continue potentially harmful medications when used for the treatment of symptoms compared to when used for preventive purposes.…”

“…Whether, and how, to de-escalate PPI in an individual patient requires careful consideration of the patient and the PPI indication. We have shown that physicians tend to poorly discriminate between patients who are likely to benefit from long-term PPI use and those who are not [ 21 ]. Thus, switching PPI to an H2 blocker would provide inferior gastroprotection in patients at high risk for peptic ulcer disease, for example [ 22 ].…”