The appropriate use of proton pump inhibitors (PPIs): Need for a reappraisal

• Published in: European journal of internal medicine 2017-01, Vol.37, p.19-24
• Main Authors: Savarino, Vincenzo, Dulbecco, Pietro, de Bortoli, Nicola, Ottonello, Andrea, Savarino, Edoardo
• Format: Article
• Language: English
• Subjects: Accepted clinical indications; Acid-related diseases; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Critical Care; Critical Illness; Duodenal Ulcer - drug therapy; Dyspepsia - drug therapy; Gastroesophageal Reflux - drug therapy; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Inappropriate Prescribing; Inappropriate use; Internal Medicine; Overprescribing costs; Overuse; Peptic Ulcer - chemically induced; Peptic Ulcer - prevention & control; Proton pump inhibitors; Proton Pump Inhibitors - therapeutic use; Respiration, Artificial; Zollinger-Ellison Syndrome - drug therapy
• ISSN: 0953-6205; 1879-0828
• DOI: 10.1016/j.ejim.2016.10.007

Abstract The advent of powerful acid-suppressive drugs, such as proton pump inhibitors (PPIs), has revolutionized the management of acid-related diseases and has minimized the role of surgery. The major and universally recognized indications for their use are represented by treatment of gastro-esophageal reflux disease, eradication of Helicobacter pylori infection in combination with antibiotics, therapy of H. pylori -negative peptic ulcers, healing and prophylaxis of non-steroidal anti-inflammatory drug-associated gastric ulcers and control of several acid hypersecretory conditions. However, in the last decade, we have witnessed an almost continuous growth of their use and this phenomenon cannot be only explained by the simple substitution of the previous H2-receptor antagonists, but also by an inappropriate prescription of these drugs. This endless increase of PPI utilization has created an important problem for many regulatory authorities in terms of increased costs and greater potential risk of adverse events. The main reasons for this overuse of PPIs are the prevention of gastro-duodenal ulcers in low-risk patients or the stress ulcer prophylaxis in non-intensive care units, steroid therapy alone, anticoagulant treatment without risk factors for gastro-duodenal injury, the overtreatment of functional dyspepsia and a wrong diagnosis of acid-related disorder. The cost for this inappropriate use of PPIs has become alarming and requires to be controlled. We believe that gastroenterologists together with the scientific societies and the regulatory authorities should plan educational initiatives to guide both primary care physicians and specialists to the correct use of PPIs in their daily clinical practice, according to the worldwide published guidelines.