Prescribing of proton-pump inhibitors: auditing the management and reasons for prescribing in Danish general practice

2019 ◽  
Vol 36 (6) ◽  
pp. 758-764
Author(s):  
Dorte E Jarbøl ◽  
Jesper Lykkegaard ◽  
Jane M Hansen ◽  
Anders Munck ◽  
Peter F Haastrup
Keyword(s):  
General Practitioner ◽  
Proton Pump Inhibitor ◽  
General Practitioners ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Patient Characteristics ◽  
Clinical Settings ◽  
Staff Members ◽  
Term Basis

Abstract Background Prescribing of proton-pump inhibitors has substantially increased. Information from clinical settings is warranted to gain insight into reasons for prescribing. Aim To investigate Danish General Practitioners’ management and reasons for prescribing of proton-pump inhibitors and to identify areas for quality improvement. Methods All general practitioners in the Region of Southern Denmark and their staff were invited to participate in a 4-week audit on all contacts with patients prescribed proton-pump inhibitors. For each contact, patient characteristics, treatment duration, dose and causes of treatment, previous gastroscopy, Helicobacter pylori test, and decision about future treatment were recorded. Results A total of 51 general practitioners and 47 staff members sampled information about 1101 and 741 patients, respectively. Proton-pump inhibitors had been taken for more than 2 years in 58% of the cases, and 64% of the patients used it daily. Treatment was based on an appropriate reason in three of the four patients, most often due to acid-related symptoms. No gastroscopy had been performed in 46% of the patients, and one of four had had a consultation with the general practitioner regarding proton-pump inhibitor within the last year. Conclusion Most patients treated with proton-pump inhibitors are treated daily, on a long-term basis, and due to symptoms. Few consultations led to alterations in treatment, and only 25% of patients had a consultation regarding proton-pump inhibitor treatment with their general practitioner within the last year. Substantial variability between general practitioners with regard to management was detected.

scholarly journals Long-term proton pump inhibitor use and the incidence of gastric cancer: A systematic review and meta-analysis

2020 ◽  
Vol 2 (1) ◽  
pp. 1-11
Author(s):  
Ju-Li Lin ◽  
Jian-Xian Lin ◽  
Chao-Hui Zheng ◽  
Jian-Wei Xie ◽  
Jia-bin Wang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Proton Pump Inhibitor ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Risk Ratios

Background: There are controverted whether the long-term use of proton pump inhibitors (PPI) will increase the risk of gastric cancer. We performed a meta-analysis to assess the risk of gastric cancer in PPI users compared with non-PPI users. Methods: The main inclusion criteria were original studies reporting the incidence of gastric cancer in PPI users compared with non-PPI users. Key outcomes were the risk ratios (RR) for gastric cancer in association with PPI users or non-PPI users. Results: We analyzed data from 8 studies, comprising more than 927,684 patients. The risk of gastric cancer in PPI users was significantly higher than in non-PPI users [RR= 2.10, 95% CI (1.17-3.97)]. The risk of gastric cancer was similar between the 2 groups when the duration was ≤1 year [RR= 2.18, 95% CI (0.66-7.11)]. While the risk of gastric cancer for PPI users was higher than in non-PPI users when the duration was between 1-3 years, ≥1 year, ≥3 years and ≥5 years. The risk of non-cardiac gastric cancer for PPI users was higher than for non-PPI users [RR= 2.66, 95% CI (1.66 -4.27)], and the risk of non-cardiac gastric cancer for PPI users was higher than for non-PPI users when the duration ≥1 year [RR= 1.99, 95% CI (1.03-3.83)], but the risk for cardiac gastric cancer was similar between the 2 groups [RR= 1.86, 95% CI (0.71-4.89)]. Conclusions: We found the long-term use of PPI (duration ≥1 year) was significantly associated with a higher risk of non-cardiac gastric cancer.

Toxicity of long-term use of proton pump inhibitors in children

2017 ◽  
Vol 103 (1) ◽  
pp. 78-82 ◽  
Author(s):  
Pauline De Bruyne ◽  
Shinya Ito
Keyword(s):  
Proton Pump Inhibitor ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Bone Fractures ◽  
Vitamin B ◽  
In Infants And Children

Proton pump inhibitor (PPI) use is becoming increasingly common. Although the toxicity profiles of PPIs are not well understood particularly in children, PPIs have been associated with increased risks of gastrointestinal and respiratory tract infection, vitamin B12 deficiency, hypomagnesaemia, bone fractures, and rebound hyperacidity after discontinuation. Prescribers should take into account that PPI uses pose toxicity risks, which remain to be fully characterised in infants and children.

Long-term proton pump inhibitor therapy and osteoporosis. Is there a real danger?

2013 ◽  
Vol 154 (26) ◽  
pp. 1005-1009 ◽  
Author(s):  
József Maléth ◽  
Péter Hegyi
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Bone Fractures ◽  
Proton Pump Inhibitor Therapy ◽  
Inhibitor Therapy ◽  
Mineral Density ◽  
Increased Risk ◽  
Underlying Mechanisms

Proton pump inhibitors are widely used in the treatment of acid-related diseases because they are considered to be effective and safe. In the past 10 years the use of proton pump inhibitors increased by over three folds, which is not associated with the increased prevalence of acid-related diseases obviously. However, like any other drugs, they have potential side effects. In recent years many studies have been published about the correlation between long-term proton pump inhibitor therapy and the increase of bone fractures. Most studies showed that long-term proton pump inhibitor therapy moderately increased fracture risk. The underlying mechanisms of increased number of bone fractures are not clarified yet. However, chronic acid suppression caused by long-term proton pump inhibitor therapy may play a crucial role in decreased absorption of calcium and vitamin B12 and, therefore, indirectly affecting the bones resulting in a decrease of bone mineral density. The available data suggest that proton pump inhibitors should be used with caution in patients with increased risk of osteoporosis. Orv. Hetil., 2013, 154, 1005–1009.

scholarly journals Costs of bleeding on long-term antiplatelet treatment without routine co-prescription of proton-pump inhibitors

2019 ◽  
pp. 174749301987965
Author(s):  
Ramon Luengo-Fernandez ◽  
Linxin Li ◽  
Peter M Rothwell ◽  
Keyword(s):  
Proton Pump Inhibitor ◽  
Secondary Prevention ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Major Bleeding ◽  
Gi Bleeding ◽  
Antiplatelet Treatment ◽  
Upper Gi ◽  
The Cost

Background Long-term antiplatelet treatment is associated with major bleeding. Aims To determine the costs associated with major bleeding in patients treated with aspirin-based antiplatelet treatment for secondary prevention of vascular events without routine prescription of proton-pump inhibitors and to estimate the likely long-term savings from routine co-prescription. Methods In a prospective population-based cohort study of TIA, ischemic stroke, and MI treated with antiplatelet drugs, we evaluated hospital care costs associated with bleed management during 10-year follow-up. Bleeding-associated costs were averaged across all patients. For upper GI-bleeds, mean costs were compared with the cost of routine co-prescription of proton-pump inhibitor. Results Among 3166 patients on antiplatelet therapy with 405 first bleeding events, the average cost of major bleeding was $13,093 (S.D. 20,501), with similar costs for upper GI bleeds and intracranial bleeds ( p = 0.235). However, total costs among the 3166 patients were higher for upper GI bleeds ($1,158,385 vs. $740,123). Averaged across all patients, the 10-year cost of major bleeding was $838 (95%CI: 680–1007), $411 due to upper GI bleeding, the cost of which increased from $175 in those aged <75 years to $644 at age ≥75 years ( p < 0.0001). The corresponding costs of routine life-long co-prescription of proton-pump inhibitor to those patients not on prior treatment were $85 (84–88) and $39 (38–42). Conclusions In secondary prevention with aspirin-based antiplatelet treatment without routine proton-pump inhibitor use, the long-term costs of upper-GI bleeding at age ≥75 years are much higher than at younger age groups, and are at least 10-fold greater than the drug cost of routine co-prescription of proton-pump inhibitor.

scholarly journals Hypomagnesemia Induced by Long-Term Treatment with Proton-Pump Inhibitors

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Simone Janett ◽  
Pietro Camozzi ◽  
Gabriëlla G. A. M. Peeters ◽  
Sebastiano A. G. Lava ◽  
Giacomo D. Simonetti ◽  
...  
Keyword(s):  
Receptor Antagonist ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Term Treatment ◽  
Cross Sectional ◽  
Magnesium Metabolism ◽  
Poor Renal Function ◽  
Long Term Treatment

In 2006, hypomagnesemia was first described as a complication of proton-pump inhibitors. To address this issue, we systematically reviewed the literature. Hypomagnesemia, mostly associated with hypocalcemic hypoparathyroidism and hypokalemia, was reported in 64 individuals on long-term proton-pump inhibitors. Hypomagnesemia recurred following replacement of one proton-pump inhibitor with another but not with a histamine type-2 receptor antagonist. The association between proton-pump inhibitors and magnesium metabolism was addressed in 14 case-control, cross-sectional studies. An association was found in 11 of them: 6 reports found that the use of proton-pump inhibitors is associated per se with a tendency towards hypomagnesemia, 2 found that this tendency is more pronounced in patients concurrently treated with diuretics, carboplatin, or cisplatin, and 2 found a relevant tendency to hypomagnesemia in patients with poor renal function. Finally, findings likely reflecting decreased intestinal magnesium uptake were observed on treatment with proton-pump inhibitors. Three studies did not disclose any relationship between magnesium metabolism and treatment with histamine type-2 receptor antagonists. In conclusion, proton-pump inhibitors may cause hypomagnesemia. In these cases, switching to a histamine type-2 receptor antagonist is advised.

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