Do Recent Reports About the Adverse Effects of Proton Pump Inhibitors Change Providersʼ Prescription Practice?

Abstract

Introduction: Proton pump inhibitors (PPI) are indicated to treat gastroesophageal reflux disease, peptic ulcer disease, dyspepsia and to prevent GI bleeding. Studies have shown increasing inappropriate PPI use. Recent reports in the press and social media have highlighted new data suggesting a possible link between chronic PPI use and several medical problems, leading to frequent patient inquiries about these associations. Providers face the challenges of balancing PPI benefits and risks. We aimed to explore providers' knowledge and attitudes toward reported adverse effects of PPI and compare gastrointestinal (GI) and Non-GI providers' prescription practices.Table 1: Concerning side effects PPI to the patients reported by providersTable 2: Concerning side effects of PPI to providersFigure 1Methods: A comprehensive non-incentivized electronic survey was sent to all providers (residents, fellows, advanced practice providers and consultants across seven specialties) at a tertiary academic center. The survey contained 21 questions covering the following provider aspects: (1) demographics (2) responses to challenging clinical scenarios dealing with PPI use. Chi-square was used to compare responses from GI providers to those from non-GI providers. Results: We sent the survey to 254 providers at our center. 88 providers (22 GI and 66 non-GI) completed the survey (34.6 % response rate). Non-GI providers included cardiology, pulmonary medicine, endocrinology, family medicine, general internal medicine, hematology/oncology, and nephrology. More GI providers reported that these potential side effects changed their practice (63.6% in GI vs 48.5 in non-GI, p-value 0.4). A larger percentage of GI providers lowered the dose of PPI (18.2 % vs 1.5% p-value 0.003). Table (1) shows what providers do when facing challenging patients on PPI therapy. When asked which side effects are more concerning to patients, GI providers were more likely to cite osteoporosis or fractures than non-GI providers (40.9% vs 15.1% p-value 0.01) and dementia (31.8% vs 25.8 p-value 0.58). Table (2) and (3) show concerning side effects per patients and providers, respectively. Most providers (GI and non-GI) agreed that educational activities (e.g. grand rounds), would be helpful to address these challenges (95.5% vs 89.4%, p-value 0.67). Conclusion: Educating patients and providers about potential side effects of PPI is imperative. More GI providers reduced the dose of PPI for their patients while more non-GI providers switched to another medication (e.g. H2 blockers) or referred to GI clinic. Educational activities might be helpful in addressing these challenges.