Survey-Based Analysis of Current Trends for Prescribing Gastrointestinal Protectants among Small-Animal General Practitioners in Portugal.

Rita Baptista,Berta São Braz,Ryane Englar,Rodolfo Leal

doi:10.3390/vetsci8050070

Rita Baptista, Berta São Braz + Show 2 more

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https://doi.org/10.3390/vetsci8050070

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Journal: Veterinary sciences	Publication Date: Apr 23, 2021
Citations: 5	License type: CC BY 4.0

Affiliation: University of Lisbon, University of Arizona

Abstract

In both human and veterinary healthcare, gastrointestinal protectants (GIPs) are considered a staple of clinical practice in that they are prescribed by general practitioners (GPs) and specialists alike. Concerning GIP use, overprescription of proton pump inhibitors (PPIs) has become a growing concern among human healthcare providers. This trend has also been documented within veterinary practice, prompting the American College of Veterinary Internal Medicine (ACVIM) to publish a consensus statement in 2018 concerning evidence-based indications for GIP use. This observational cross-sectional study evaluated self-reported prescribing protocols among Portuguese GPs to determine whether there is adherence to the consensus guidelines. Respondents were Portuguese GPs recruited by social media posts in veterinarian online forums. Data were collected from 124 respondents concerning their GIPs of choice and their rationales for prescribing them. Data were mined for prescription patterns and protocols. Among GIPs, PPIs were prescribed more often. Rationales for use included gastrointestinal ulceration and erosion (GUE), prophylactic management of nonerosive gastritis, pancreatitis, reflux esophagitis, and steroid-induced ulceration. Once-daily administration of PPIs was the most frequent dosing regime among respondents. Ninety-six percent of PPI prescribers advocated that the drug be administered either shortly before or at mealtime. Forty-nine percent of respondents supported long-term use of PPIs. Fifty-nine percent of respondents acknowledged discontinuing PPIs abruptly. This study supports that Portuguese GPs commonly prescribe GIPs in accordance with ACVIM recommendations to medically manage GUE. However, misuse of GIPs does occur, and they have been prescribed where their therapeutic value is debatable. Educational strategies should target GPs in an effort to reduce GIP misuse.

Highlights

GPstoto determine whether current recommendations provided by the consensus statement determine whether current recommendations provided by the American College of Veterinary Internal Medicine (ACVIM) consensus state‐
pump inhibitors (PPIs) are more effective for management of acid-related disorders [12], our study reveals that a considerable number (16%) of Portuguese general practitioners (GPs) consider histamine type-2 receptor antagonists (H2 RAs) as a preferable choice
Following ACVIM consensus recommendations, gastrointestinal protectants (GIPs) are being prescribed by Portuguese small-animal GPs for gastrointestinal ulceration and erosion (GUE) and prophylactic management of reflux esophagitis, and PPIs, namely omeprazole, have become their preferred drugs of choice

Summary

Introduction

Gastrointestinal protectants (GIPs) have been prescribed by human healthcare providers with increased frequency to manage presumptive dyspepsia [1]. Treatment is often an empirical approach to symptom management rather than evidence based; pharmaceuticals are routinely prescribed without a definitive diagnosis to support. Proton pump inhibitors (PPIs) are overprescribed and/or misused [3,4,5,6,7]. The safety profile of PPIs has not been called into question, recent studies raise concerns that extended use, when unwarranted, may be deleteri- 4.0/). Rebound acid secretion can result from short-term treatment with PPIs, necessitating prolonged use of acid suppressants [8,9]

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