Abstract
PurposeGastric acid suppressants are commonly used in the United States, and while generally well-tolerated, long-term use has been associated with infection, bone fractures, and nutrient malabsorption. The purpose of this study was to describe national trends in gastric acid suppressant use over a 7-year period.MethodsThis was a cross-sectional study using data from the National Ambulatory Medical Care Survey from 2009 to 2015. Gastric acid suppressant use was defined as any outpatient visit with a documented prescription for a proton pump inhibitor or histamine-2 receptor antagonist documented during the outpatient visit. Sample data weights were used to extrapolate to national estimates. Use was calculated as the number of prescriptions per total outpatient visits per year. Appropriateness of prescribing was assessed using FDA-approved indications listed in each visit.ResultsThese data represent 6.8 billion patient outpatient visits between 2009 and 2015, of which nearly 600 million (8.8%) had documented gastric acid suppressant use. The median (IQR) age of gastric acid suppressant users and non-gastric acid suppressant users was 62 (50–73) and 49 (25–65), respectively. Gastric acid suppressant use decreased from 9.0% in 2009 to 7.7% in 2012, and then increased to 9.7% in 2015. Proton pump inhibitor use was slightly higher in the Midwest (8.3%). Only 15.8% of gastric acid suppressant users had a documented indication.ConclusionsProton pump inhibitor use increased after 2012, and the majority of gastric acid suppressant users did not have a documented indication. Judicious gastric acid suppressant prescribing needs to be exercised, especially in the context of new safety data regarding long-term proton pump inhibitor use.
Highlights
Gastric acid suppressant use was defined as any outpatient visit with a documented prescription for a proton pump inhibitor or histamine-2 receptor antagonist documented during the outpatient visit
Gastric acid suppressant use decreased from 9.0% in 2009 to 7.7% in 2012, and increased to 9.7% in 2015
Proton pump inhibitor use was slightly higher in the Midwest (8.3%)
Summary
Gastric acid suppressants (GASs), including proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), are therapeutic agents used for gastrointestinal disorders such as gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD). PPIs became especially prevalent between 1995 and 2006, with PPI treatment (43.9 prescriptions per 1000 visits) greatly outpacing the increase in GERD diagnoses (at 16.3 per 1000 visits) during that time period, likely due to their availability over-the-counter [2]. Between 2002 and 2009, the number of outpatient visits with documented PPI use more than doubled, from 30 million to 84 million; no documented gastrointestinal complaints or diagnoses were found in over 60% of these visits [3]. A 2015 study found that roughly 30 out of every 1,000 adult patients among 5 million Medicaid members had a prescription for a H2RA [4]
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