Deprescribing Inappropriate Proton Pump Inhibitors in a Family Medicine Residency Practice Office

Introduction: Proton pump inhibitors (PPIs) are often prescribed beyond their medically-approved duration of use. Long-term PPI use has been linked with numerous adverse effects and contributes to polypharmacy. This study sought to understand the effect of evidence-based education to resident and faculty physicians on deprescribing inappropriate PPIs. We hypothesized that this educational intervention would result in fewer inappropriate PPI prescriptions. Methods: We performed a chart review on all adult patients in a family medicine residency program practice, identifying those inappropriately taking PPIs. All physicians in the practice participated in an educational intervention regarding deprescribing inappropriate PPIs and were given frequent reminders to continue their deprescribing efforts. We reviewed charts at the end of the study to identify patients with successful deprescribing attempts. Results: Of the 187 patients prescribed inappropriate PPIs in the study, 100 remained on PPIs at the end of the study (46.6% success rate). There was a significant decrease in the number of patients inappropriately prescribed PPIs by each physician over the course of the study, from a mean of 17.0 (beginning) to 9.1 (end). Conclusion: Physician education with reminders is an effective means of reducing the number of inappropriate PPIs prescribed in a family medicine residency practice. Future studies could investigate the effectiveness of educational interventions with other medication classes that are often prescribed inappropriately.

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Proton Pump Inhibitors and Fracture Risk: A Review of Current Evidence and Mechanisms Involved

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16091571 ◽

2019 ◽

Vol 16 (9) ◽

pp. 1571 ◽

Cited By ~ 20

Author(s):

Benjamin Ka Seng Thong ◽

Soelaiman Ima-Nirwana ◽

Kok-Yong Chin

Keyword(s):

Fracture Risk ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Bone Health ◽

Current Evidence ◽

Mineral Absorption ◽

Number Of Patients ◽

The Relationship ◽

Fracture Risks

The number of patients with gastroesophageal problems taking proton pump inhibitors (PPIs) is increasing. Several studies suggested a possible association between PPIs and fracture risk, especially hip fractures, but the relationship remains contentious. This review aimed to investigate the longitudinal studies published in the last five years on the relationship between PPIs and fracture risk. The mechanism underlying this relationship was also explored. Overall, PPIs were positively associated with elevated fracture risk in multiple studies (n = 14), although some studies reported no significant relationship (n = 4). Increased gastrin production and hypochlorhydria are the two main mechanisms that affect bone remodeling, mineral absorption, and muscle strength, contributing to increased fracture risk among PPI users. As a conclusion, there is a potential relationship between PPIs and fracture risks. Therefore, patients on long-term PPI treatment should pay attention to bone health status and consider prophylaxis to decrease fracture risk.

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Proton Pump Inhibitors and Fractures in Adults: A Critical Appraisal and Review of the Literature

International Journal of Endocrinology ◽

10.1155/2021/8902367 ◽

2021 ◽

Vol 2021 ◽

pp. 1-15

Author(s):

Silvia Irina Briganti ◽

Anda Mihaela Naciu ◽

Gaia Tabacco ◽

Roberto Cesareo ◽

Nicola Napoli ◽

...

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

Bone Health ◽

Meta Analysis ◽

Fragility Fractures ◽

High Dose ◽

Case Control Studies ◽

Number Of Patients ◽

Increased Risk

Despite the large number of patients worldwide being on proton pump inhibitors (PPIs) for acid-related gastrointestinal disorders, uncertainty remains over their long-term safety. Particularly, the potential side effects of these drugs on bone health have been evaluated in the last years. The purpose of our narrative review is to gather and discuss results of clinical studies focusing on the interactions between PPIs and fracture risk. Data generated mainly from nested case-control studies and meta-analysis suggest that long-term/high-dose PPIs users are characterized by an increased risk of fragility fractures, mainly hip fractures. However, in these studies, the PPIs-induced bone impairment is often not adjusted for different confounding variables that could potentially affect bone health, and exposure to PPIs was reported using medical prescriptions without adherence evaluation. The mechanisms of the PPI-related bone damage are still unclear, but impaired micronutrients absorption, hypergastrinemia, and increased secretion of histamine may play a role. Clinicians should pay attention when prescribing PPIs to subjects with a preexistent high risk of fractures and consider antiosteoporotic drugs to manage this additive effect on the bone. However, further studies are needed to clarify PPIs action on the bone.

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Problems Associated with Deprescribing of Proton Pump Inhibitors

International Journal of Molecular Sciences ◽

10.3390/ijms20215469 ◽

2019 ◽

Vol 20 (21) ◽

pp. 5469 ◽

Cited By ~ 6

Author(s):

Helgadottir ◽

Bjornsson

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

Adverse Drug Events ◽

Tumor Formation ◽

Term Therapy ◽

Special Focus ◽

Global Issue ◽

Number Of Patients ◽

Long Term Therapy

Proton pump inhibitors (PPIs) are recommended as a first-line treatment for gastroesophageal reflux disease (GERD) and other acid related disorders. In recent years, concerns have been raised about the increasing prevalence of patients on long-term PPI therapy and inappropriate PPI use. It is well known that short-term PPI therapy is generally well tolerated and safe; however, their extensive long-term use is a major global issue. One of these long-standing concerns is PPI-induced gastrin elevation secondary to hypoacidity. Hypergastrinemia is believed to play a role in rebound hyperacidity when PPIs are discontinued resulting in induced dyspeptic symptoms that might result in the reinstitution of therapy. Gastrin exerts tropic effects in the stomach, especially on enterochromaffin-like (ECL) cells, and concerns have also been raised regarding the potential progression to dysplasia or tumor formation following long-term therapy. It is well known that a substantial number of patients on long-term PPI therapy can discontinue PPIs without recurrence of symptoms in deprescribing trials. What is unknown is how sustainable deprescribing should be undertaken in practice and how effective it is in terms of reducing long-term outcomes like adverse drug events, morbidity and mortality. Moreover, there is no clear consensus on when and how deprescribing strategies should be attempted in practice. This review sought to summarize the harms and benefits of long-term PPI therapy with special focus on gastrin elevation and its relation to deprescribing studies and future interventions that may improve PPI use.

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Faculty Opinions recommendation of The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727370420.793536966 ◽

2017 ◽

Author(s):

Peter Kahrilas

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

Best Practice ◽

American Gastroenterological Association ◽

Expert Review ◽

Risks And Benefits

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Long-term continuous use of proton-pump inhibitors is associated with renal function decline in patients without acute kidney injury

Clinical and Experimental Nephrology ◽

10.1007/s10157-021-02066-z ◽

2021 ◽

Author(s):

Yutaka Hatakeyama ◽

Taro Horino ◽

Tatsuki Matsumoto ◽

Yoshio Terada ◽

Yoshiyasu Okuhara

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Kidney Injury ◽

Renal Function Decline ◽

Continuous Use

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

Gastroenterology Research and Practice ◽

10.1155/2015/951768 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 22

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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