Use and Abuse of Proton Pump Inhibitors

Abstract

Purpose: To determine the utilization of proton pump inhibitors (PPIs) at an academic medical center we evaluated the indications for PPI use in hospitalized patients, and the frequency in which patients placed on a PPI during hospitalization were discharged on a PPI. Methods: We performed a prospective analysis of 502 consecutive patients admitted at the Medical College of Georgia (MCG) and the Children's Medical Center (CMC) who received a PPI. Patients who were on a PPI at home and not placed on one at the time of admission were not accounted for in this study. We recorded demographics, indication for use, hospital service prescribing PPI, route of administration, PPI use prior to admission, and discharge PPI medication for each admission. Results: Between May 6th and June 19th, 2005, a total of 2,497 patients were admitted to MCG and CMC. 502 were prescribed a PPI. Analysis of the adult population revealed 463 (26%) patients admitted to MCG were prescribed a PPI. Patients received a PPI for the following indications: stress ulcer prophylaxis (SUP)-53%, GERD-30%, not documented -15%, GI bleed-5%, continuation of home medication-4%, other-4%, esophagitis-0.1%, and peptic ulcer disease-0.1%. 37% of patients were on a PPI prior to admission. Although 246 patients (53%) were placed on a PPI for prophylactic purposes, only 18% were admitted to the intensive care unit. Overall, 300 of the 463 patients (∼65%) were prescribed a PPI without a documented appropriate indication. Upon discharge, 50% of patients were prescribed a PPI. 22% of patients placed on a PPI for prophylactic purposes were discharged on a PPI. Overall, about 55% of patients were discharged on a PPI without appropriate indication or documentation. Conclusion: There is significant overuse of PPIs in the inpatient setting at our institution with about 26% of patients receiving a PPI on admission, and 55% of patients discharged on a PPI without any clear indication or documentation. Caution must be used when initiating PPI therapy in the hospital setting; long-term therapy often continues unnecessarily after discharge leading to increased healthcare costs, polypharmacy, and increased risk for potential adverse effects including Clostridium difficile diarrhea, community-acquired pneumonia, and intestinal bacterial overgrowth. Therefore, physicians need to be aware of the indications and possible consequences of PPI use in hospitalized patients.