Proton pump inhibitor deprescribing interventions in primary care: A systematic review

Inappropriate use of proton pump inhibitors (PPIs) is associated with severe adverse drug reactions and may significantly increase health care costs. Deprescribing should be considered when inappropriate use is identified. To evaluate the effectiveness of a patient- and general practitioner (GP)-facing intervention in reducing potentially inappropriate PPI use in primary care. This pragmatic, cluster-randomized, open-label, clinical trial was conducted between November 12, 2020, and November 11, 2021. Participants were adults aged 18 years or older with at least 1 year of PPI use in GP practices in 2 regions of western France, and their GPs were included. Data were analyzed from January to July 2025. GP practices were randomized to 3 groups in a 1:1:1 ratio as follows: (1) a patient- and GP-facing deprescribing intervention combining a patient education brochure on PPI deprescribing posted directly to patients with a letter outlining a PPI deprescribing algorithm sent to their GPs; (2) a GP-facing intervention, in which only the GP received the letter and algorithm; or (3) usual care. The primary outcome was PPI dose reduction, defined as a 50% or more reduction in annual PPI use, measured in defined daily doses (DDDs) and proxied by reimbursement claims. Secondary measures included Gastroesophageal Reflux Disease Impact Scale (GIS) scores, assessed in a 10% sample. A total of 1498 GPs and 34 409 patients were included from 683 primary care practices. The mean (SD) patient age was 68.6 (14.0) years, and 19 507 (56.7%) were female. Mean (SD) baseline annual PPI use was 413.7 (113.9) DDDs. PPI dose reduction was higher in the patient- and GP-facing intervention group compared with the usual care groups (1710 of 11 442 patients [14.9%] vs 825 of 11 732 [7.0%]; adjusted absolute difference, 6.9%; 95% CI, 5.7%-8.3%; P < .001) and with the GP-facing intervention (1710 of 11 442 patients [14.9%] vs 862 of 11 235 [7.7%]; adjusted absolute difference, 6.7%; 95% CI, 5.4%-8.2%, P < .001). GIS scores did not significantly differ between groups. This randomized clinical trial found that the patient- and GP-facing intervention was effective in reducing potentially inappropriate PPI use without any meaningful impact on long-term gastroesophageal reflux disease activity. ClinicalTrials.gov Identifier: NCT04255823.

Proton pump inhibitors are widely used to treat gastrointestinal conditions, but prolonged use increases the risk of infections, fractures, kidney disease, and other adverse outcomes, particularly in adults aged 65 years and older. Despite guideline recommendations for limited duration, inappropriate prescribing remains common, contributing to adverse outcomes and increased health care costs. Baseline audits at a 24-bed telemetry unit in a Texas community hospital revealed that 35.3% of older adults were prescribed proton pump inhibitors without appropriate indication. The purpose of this initiative was to evaluate the effect of a nurse-led proton pump inhibitor medication review using a structured proton pump inhibitor deprescribing algorithm. This 16-week quality improvement initiative, guided by the Iowa Model of Evidence-Based Practice, included an 8-week preimplementation phase followed by an 8-week postimplementation assessment phase. Forty-five nurses were trained to apply the deprescribing algorithm in collaboration with physicians and pharmacists at patient admission and discharge. Implementation tools included electronic health record text templates, patient education resources, and interprofessional huddles. Among 186 patient records reviewed, inappropriate proton pump inhibitor use declined from 35% to 5% (P < .001). No adverse gastrointestinal events were reported. Informal feedback showed increased nurse confidence in and knowledge of deprescribing practices. This nurse-led intervention significantly reduced inappropriate proton pump inhibitor prescriptions and enhanced patient safety. Integration of decision tools, education, and interprofessional collaboration supported sustainability. The model is scalable to other medication stewardship efforts in acute care.

To identify drug-related problems (DRPs) associated with proton pump inhibitors (PPIs) and their influencing factors among hospitalized nephrology patients, thereby providing evidence for the rational use of PPIs. A retrospective cohort of internal nephrology inpatients who received PPIs between June 2024 and May 2025 was assembled. Clinical pharmacists applied the PCNE classification system (version 9.1) to identify and categorize PPI-related DRPs. Univariate and multivariate logistic regression analyses were performed to explore factors contributing to inappropriate PPIs use. A total of 520 patients were included, of which 241 patients (46.34%) experienced 303 DRPs. The most frequent problems involved drug selection and treatment duration. Multivariate analysis revealed that the following variables were independently associated with inappropriate PPIs use: purpose of PPI application (OR = 0.455, 95% CI 0.305-0.680, p < 0.001), antiplatelet agents (OR = 1.552, 95% CI 1.062-2.268, p = 0.023), anti-infective drugs (OR = 1.922, 95% CI 1.313-2.813, p = 0.001), and peritoneal dialysis (OR = 1.743, 95% CI 1.028-2.955, p = 0.039). Systematic identification of PPI-related DRPs and analysis of their determinants by clinical pharmacists will substantially promote the rational use of PPIs in hospitalized patients with renal disease.

Background and objectives: Life expectancies have increased globally, including in Romania, leading to an aging population and thus increasing the burden of chronic diseases. Over 80% of individuals over 65 have more than three chronic conditions, with many exceeding ten and often requiring multiple medications and supplements. This widespread polypharmacy raises concerns about drug interactions, side effects, and inappropriate prescribing. This review examines the impact of polypharmacy in older adult patients, focusing on the physiological changes affecting drug metabolism and the potential risks associated with excessive medication use. Special attention is given to proton pump inhibitors (PPIs), a commonly prescribed drug class with significant benefits but also risks when misused. The aging process alters drug absorption and metabolism, necessitating careful prescription evaluation. Methods: We conducted literature research on polypharmacy and PPIs usage in the older adult population and the risk associated with this practice, synthesizing 217 articles within this narrative review. Results: The overuse of medications, including PPIs, may lead to adverse effects and increased health risks. Clinical tools such as the Beers criteria, the STOPP/START Criteria, and the FORTA list offer structured guidance for optimizing pharmacological treatments while minimizing harm. Despite PPIs' well-documented safety and efficacy, inappropriate long-term use has raised concerns in the medical community. Efforts are being made internationally to regulate their consumption and reduce the associated risks. Conclusions: Physicians across all specialties must assess the risk-benefit balance when prescribing medications to older adult patients. A personalized treatment approach, supported by evidence-based prescribing tools, is essential to ensure safe and effective pharmacotherapy. Addressing inappropriate PPI use is a priority to prevent potential health complications.

Background/Objectives: Up to 25-70% of proton-pump inhibitor (PPI) prescriptions worldwide lack an evidence-based indication, exposing patients to avoidable adverse events and unnecessary costs. Community pharmacists (CPs) are well-equipped to curb the misuse of PPIs. This study aimed to quantify CPs' knowledge, attitudes, and practices (KAPs) regarding PPIs in two high-use Middle-Eastern markets and determine how demographic and professional factors influence guideline-adherent PPI use. Bridging this gap is crucial to ensure pharmacists can promote rational PPI use, provide accurate patient counseling, and reduce the likelihood of adverse outcomes. Methods: An online cross-sectional survey was undertaken between May 2024 and July 2024 to investigate the KAPs of CPs in Egypt and Iraq toward PPI use. The self-developed thirty-item questionnaire (17 knowledge, 11 attitude, and 6 practice items) was piloted with 30 CPs. A sample size of 385 CPs was required based on an estimated 93,000 community pharmacists in Egypt and 22,120 in Iraq; however, to improve statistical power, we aimed to include >500 CPs. Results: A total of 527 CPs from Egypt and Iraq completed the survey. The total median scores for knowledge, attitude, and practice were 11 out of 17 (IQR: 9-16), 9 out of 11 (IQR: 6-12), and 5 out of 6 (IQR: 3-8), respectively. CPs with >20 years of experience and those who relied on clinical guidelines as a primary information source demonstrated a median knowledge score significantly higher than those with fewer years of experience (p = 0.001 and 0.028, respectively). There was a significant positive association between knowledge and attitude, knowledge and practice, and attitude and practice scores (coefficients: 0.832, 0.701, and 0.445, respectively). Conclusions: Although their attitudes and practices regarding PPI use were satisfactory, the knowledge of CPs about the judicious use of PPIs requires improvement. Thus, a call for action targeting their tailored education and training is necessary to address these knowledge gaps regarding PPIs identified, including PPI adverse-effect profiles, evidence-based indications, and deprescribing criteria, and to foster informed medication attitudes and practices. Such education and training can reinforce guideline adherence, enhance patient counseling skills, and ultimately reduce inappropriate PPI use.

Introduction and aimAutoimmune chronic atrophic gastritis (ACAG) is a chronic autoimmune disorder whose diagnostic complexity arises from diverse symptoms mimicking other gastrointestinal disorders, often leading to misdiagnosis. Despite diagnosis, patients are often treated with proton pump inhibitors (PPIs) before consulting a gastroenterologist, emphasizing the need for accurate identification and management of ACAG in primary care. This study aimed to explore factors influencing disease progression.Materials and methodsWe retrospectively analyzed demographic data, medical history, use of PPI, and clinical, endoscopic, and histological data of consecutive adult patients with a histological diagnosis of ACAG referred to our outpatient clinic between January 2017 and December 2022. Operative link on gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) were recorded for each patient.ResultsSeventy patients with a diagnosis of ACAG (female 74.3%, median age 63.9 years) made up the study cohort. Eighteen patients were asymptomatic (25.7%), while 13 (18.6%), and 10 (14.3%) patients reported epigastric pain and asthenia, respectively. Median age at diagnosis of ACAG was 60.7 years [interquartile range (IQR): 46.4–68.2]. OLGA and OLGIM scores III and IV were associated with higher age at diagnosis (OLGA: 69.2 years, IQR: 65.2–75.1 vs. 57.1 years, IQR: 44.4–67.1, P = 0.005; OLGIM; 68.0 years, IQR: 56.1–73 vs. 58.5 years, IQR: 44.3–67.4, P = 0.031). The use of full-dose PPI was more frequent in patients with higher OLGA and OLGIM scores (OLGA I–II vs. III–IV: n = 11, 17.7% vs. n = 4, 50.0%, P = 0.036; OLGIM 0–II vs. III–IV: n = 10, 16.7% vs. n = 5, 50.0%, P = 0.017).ConclusionACAG patients with severe atrophy and those with severe gastric intestinal metaplasia were most likely PPI users. Timely diagnosis and heightened awareness among nongastroenterologists regarding the inappropriate use of PPI in this context are crucial.

In patients with acute upper GI bleeding (UGIB), current best practice is to discontinue or transition (to oral) intravenous proton pump inhibitors (PPIs) when esophagogastroduodenoscopy (EGD) reveals low risk or no peptic ulcer disease (PUD). This retrospective study from a large academic medical center evaluated the use of intravenous PPIs in patients admitted with acute UGIB due to low-risk PUD or non-PUD UGIB. Complete clinical data including endoscopic lesions and the duration of intravenous PPI therapy were recorded. Of 335 patients with acute UGIB, 253 had no PUD or an ulcer with only low-risk stigmata; 79 patients [31% (95% CI: 26%-37%)] received the appropriate duration of IV PPI. For patients with low-risk PUD (n=42), patients received on average 5.3 excess doses of intravenous PPI, and patients receiving continuous intravenous PPI received an average of 41 additional hours of IV PPI. Likewise, excess PPI therapy was common for patients found to have no lesions or no PUD. Lesions most often associated with inappropriate IV PPI use included: no identifiable lesion (n=59; 34%), low-risk PUD (n=42; 24%), gastritis (n=31; 18%), esophagitis (n=24, 14%), and AVMs (n=21, 12%). The length of hospital stay was shorter in patients who received appropriate PPI therapy after EGD compared with those who did not (4.3 vs. 7.2d, P =0.001). IV PPIs are grossly overused in patients with UGIB, suggesting that there is substantial room for improvement in the use of PPIs in patients with acute UGIB.

Mo1222: ADDRESSING INAPPROPRIATE PROTON PUMP INHIBITORS USE IN ICU SETTING: A QUALITY IMPROVEMENT INITIATIVE.

Proton pump inhibitors (PPIs) are widely prescribed for acid-related disorders; however, concerns have emerged regarding their misuse, particularly in patients with liver cirrhosis. This study aimed to assess the appropriateness of PPI prescriptions in patients with cirrhosis and to identify factors contributing to their overutilization in this patient population. In this cross-sectional study, 1000 patients with cirrhosis receiving PPIs were enrolled. Data on demographics, clinical parameters, and endoscopic findings were collected, and indications for PPI therapy were assessed according to established guidelines. Among patients with cirrhosis, 60.5% were prescribed PPIs, with pantoprazole being the most prescribed (55.7%). Inappropriate PPI use was observed in 53.6% of the patients, mainly because of lacking an approved indication (78.54%) or exceeding the recommended treatment duration (21.46%). Causes contributing to misuse included prolonged PPI use postendoscopic band ligation (29.1%), extended treatment for functional dyspepsia (21.46%), failure to discontinue PPIs upon hospital discharge (17.54%), using PPIs for preventing portal hypertensive gastropathy (PHG) or variceal bleeding (16.42%), and stress ulcer prophylaxis in non-ICU patients (15.86%). Multivariate analysis identified independent predictors of inappropriate PPI use, including Child classification C, Mayo End-Stage Liver Disease score greater than 18, hepatocellular carcinoma, and previous variceal bleeding, whereas hematemesis was identified as an independent predictor of appropriate use. This study underscores the prevalent inappropriate prescription of PPIs in patients with liver cirrhosis, particularly in those with advanced liver disease or a history of variceal bleeding. Enhancing prescribing practices and adhering to evidence-based guidelines are essential to mitigate the risks associated with PPI misuse in patients with cirrhosis.

Although proton pump inhibitors (PPIs) are extensively used for acid-related disorders, their inappropriate administration for stress ulcer prophylaxis (SUP) in hospitalized patients remains a cause for concern. This study aimed to evaluate the extent of PPI misuse for SUP in a tertiary care setting, identify contributing factors, and assess adherence to clinical guidelines. A cross-sectional study was conducted over one year, including hospitalized patients receiving PPIs for SUP without documented indications. Data were collected through medical record reviews and physician questionnaires to determine prescription patterns, indications, and adherence to guidelines. Statistical analysis was performed using SPSS (IBM Corp., Armonk, NY, USA), employing chi-square tests and descriptive statistics. Among 274 patients, only 31.02% had appropriate indications for PPI use, while 68.98% received PPIs without meeting prophylactic criteria. Overall, 33.58% of prescriptions adhered to guidelines, whereas 66.42% deviated. The average duration of PPI use was 10.3 ± 4.7 days: 47.45% used PPIs for seven or fewer days, 31.02% for eight to 14 days, and 21.53% for more than 14 days. Guideline-based prescribing accounted for 35.77%, while 40.88% of prescriptions were attributed to defensive prescribing. Inappropriate PPI use was significantly associated with older age (p = 0.034) and ICU admission (p = 0.001). PPI overuse for stress ulcer prevention is prevalent among hospitalized patients. Targeted interventions are needed to improve adherence to evidence-based guidelines and curb unnecessary prescribing, particularly in relation to defensive medical practices.

Inappropriate use of proton pump inhibitors (PPIs) for prophylaxis among hospitalized patients continues to be a significant issue. Previous interventions have often been ineffective and lack evaluation of their longer-term impacts. This study aims to assess the clinical and economic effects of a nudge theory-based multifaceted intervention on reducing inappropriate PPI prophylaxis in hospitalized patients. This non-randomized controlled study was carried out in a teaching hospital's wards from January 2021 to June 2023, with a 12-month pre-intervention period, a 12-month intervention period (including the first and second stages of intervention), and a post-intervention period with 6-month follow-up. The intervention, based on nudge theory, was implemented among 114 doctors across 10 wards, sequentially involved peer comparison, information provision, and face-to-face feedback. The outcomes were assessed by randomly selecting cases of adult patients who received at least one PPI treatment during hospitalization, and the statistical analysis included univariate analysis, and multivariate and subgroup analyses. The study included 1782 patients, with a median age of 61 years. During and after intervention, the rate of appropriate PPI use significantly increased by 2.83- to 5.47-fold, rising from 23.82% (147/617) to 46.96% (139/296) after the first stage, to 63.13% (202/320) after the second stage, and remained at 53.01% (291/549) later on. The rate of PPI injections decreased from 92.54 to 74.13-84.12%, the median defined daily doses from 16 to 7-12, and PPI-related expenditures from 484.80 to 156.00-262.99 CNY per-patient. The cost associated with inappropriate PPI use dropped from 161.60 to 0-45.58 CNY per-patient. Subgroup analyses supported these findings. A nudge theory-based multifaceted intervention led to increased appropriate PPI use, decreased PPI injections, and cost savings, with benefits lasting at least 6 months post-intervention.

BackgroundLong-term inappropriate use of proton pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease (GERD) and dyspepsia is a common issue that can lead to unnecessary healthcare costs and potential adverse effects. Alternative treatments, such as episodic alginate therapy, may offer a more cost-effective and clinically appropriate approach.ObjectiveTo investigate the financial impact of transitioning patients from long-term inappropriate PPI use to episodic alginate treatment for GERD and dyspepsia, from the perspective of the National Health Service (NHS) England.MethodsA budget impact model was used to compare costs over a 5-year period for adult patients using long-term inappropriate PPIs, with and without alginate treatment. By the fifth year, 20% of patients were assumed to have switched to alginate treatment. In this model, the base case analysis included only drug costs, while a scenario analysis also considered adverse effect costs.ResultsOver the 5-year period, net savings of £11.5 million were observed in drug acquisition costs when 20% of patients (4.8 million) successfully transitioned to alginate treatment. When adverse effect costs were included in the scenario analysis, net savings increased to £16.6 million due to a slight reduction in the number of adverse effects. One-way sensitivity analysis confirmed the robustness of these results.ConclusionsTransitioning patients from long-term PPI use to episodic alginate treatment is beneficial for patients, potentially reducing adverse effects, and can lead to significant budgetary cost savings, which can be reallocated.

Background and Objectives: Proton Pump Inhibitors (PPIs) are the most effective agents for treating acid-related gastrointestinal disorders. The prescription of an intravenous (IV) formulation of PPIs has increased dramatically. The aims of this study were to assess the appropriateness of IV PPI use and to define the risk factors and outcomes associated with its inappropriate use. Materials and Methods: A case-control retrospective study included all the hospitalized patients who received IV PPIs was conducted. Patient health records were reviewed, data were collected covering the period of the individual patients' admission to the hospital until discharge or death, and over the 3-month post-discharge period. The appropriateness of the IV PPI use and the resulting clinical outcomes were analyzed. Results: Overall, 540 patients were analyzed. Among them, 130/540 (24%) had inappropriate PPI use in terms of indication, dosage, and duration of treatment vs. 410 patients who had appropriate indications. Two parameters were associated with inappropriate use: congestive heart failure (OR 1.77; p = 0.02) and prescription of IV PPIs by surgeons vs. internists (OR 1.53; p = 0.05). Conclusions: Inappropriate IV PPI use is still common in daily clinical practice. Significant predictors of inappropriate use were the presence of congestive heart failure, elderly age, current use of anticoagulants and antithromotics, and the cases managed by surgeons, naturally due to suspected upper gastrointestinal bleedings.

BackgroundDespite being cornerstone medications for managing gastrointestinal disorders, proton pump inhibitors (PPI) have raised concerns due to inappropriate prescribing and overutilization, their potential side effects, and interactions with other medications. General practitioners (GPs) provide long-term patient follow-up and are targets to promote PPI deprescribing to reach the widest possible population. GPs practicing in rural settings encounter unique challenges as their numbers dwindle and their workload increases. Hence, targeted educational interventions are crucial to promote appropriate prescribing practices in such underserved areas.MethodsWe developed a continuing medical education (CME) program focused on PPI deprescribing for GPs in rural settings. The program comprised of an interactive training session featuring clinical cases, an open discussion, and distribution of educational materials. We assessed the program’s effectiveness using a two-level Kirkpatrick model, evaluating participant satisfaction and knowledge levels through pre- and post-course questionnaires.ResultsThirty-three GPs participated, with 61.9% working in semi-rural and 38.1% in rural areas (21 responded to the 1st questionnaire, 14 to the 2nd ). Median medical experience was 6 years, with 61.9% serving as internship supervisors. Despite 95.2% acknowledging PPI overprescription, none had previously participated in dedicated PPI CME programs. The open discussion session provided valuable insights into various topics related to PPI use and gastrointestinal health. Participants expressed high satisfaction with the program (average rating of 9.1/10) and 92.9% reported changes in practice, including increased awareness of inappropriate PPI prescriptions. Indeed, 92.9% of GPs identified inappropriate PPI use following the course. 57.1% of participants utilized the provided educational materials. The main practice changes observed included an increased reassessment rate of PPI indications (71.4% at each renewal after vs. 19% before, 28.6% non-systematically after vs. 66.8% before, 0% rarely after vs. 14.3% before; p = 0.006), the necessity for more than one consultation to deprescribe (64.3% after vs. 23.8% before; p = 0.021), systematic utilization of gradual cessation of PPI (100% vs. 61.9%; p = 0.039) and more frequent use of additional medication (92.9% vs. 57.1%; p = 0.022), primarily antiacids (92.3%).ConclusionsOur study underscores the effectiveness of targeted CME programs in promoting appropriate prescribing practices and enhancing knowledge among GPs in rural settings. Despite the challenges encountered in deprescribing PPI, the program facilitated proactive approaches in managing treatment discontinuation failures. Tailored educational interventions are essential for mitigating medication prescribing challenges and improving patient outcomes in rural primary care settings.Trial registrationsNot applicable.

Background/Objectives: Proton pump inhibitors (PPIs) are amongst the most commonly prescribed classes of medication. However, inappropriate PPI use can lead to several adverse drug reactions (ADRs). Limited data exist on factors contributing to the risk of ADRs associated with PPI prescribing patterns in the Eastern Region of Saudi Arabia. This retrospective, cross-sectional study aimed to assess the prevalence and the pattern of PPI use and to identify factors contributing to the risk of ADRs. Methods: Data were collected from electronic medical records of patients at Al-Qateef Central Hospital from January 2020 to December 2021. The inclusion criteria included patients aged ≥40 years attending an outpatient medical care clinic. PPI prescribing patterns were categorized based on their dosage intensity into low-dose, medium-dose (MD), and high-dose (HD) categories. Binary and multinominal logistic regression models were used to determine the relationship between PPI prescribing patterns and use, categorized by MD or HD, and patient characteristics, adjusted for significant covariates. Results are presented as adjusted odds ratio (OR) with corresponding 95% confidence intervals (95% CI). Results: The study included 41,084 patients. The prevalence of PPI prescribing was 31%. PPI users were more frequently found to be females than males (52% vs. 50%, p = 0.013); they were also likely to be prescribed more medications (7 vs. 6, p < 0.001), but less likely to have gastritis-related diseases (34% vs. 32%, p < 0.001) compared to non-users. PPI HD users were more likely male (56% vs. 43%, p < 0.001), older (53 vs. 52 years, p < 0.001), and prescribed more medications (11.8 vs. 2.8, p < 0.001) compared to MD users. PPI usage was associated with concurrent use of antiplatelet drugs (OR = 1.08, 95% CI 1.01-1.15). An increasing number of prescribed medications was associated with HD usage (OR = 1.13, 95% CI 1.12-1.14), but negatively associated with MD usage (OR = 0.7 95% CI 0.69-0.71). Female gender was negatively associated with HD usage (OR = 0.85, 95% CI 0.79-0.91). Conclusions: Our findings indicate that 31% of the included cohort were prescribed PPI. Inappropriate PPI prescribing related to the drug's omission is a concern as PPI non-users presented with valid indications such as gastritis. Male gender and increasing NPM were the common factors contributing to increased risk of PPI ADR. This study points to the importance of re-evaluating PPI use to ensure effective therapy with minimum risks of ADR.

Background Proton pump inhibitors (PPIs) are commonly prescribed to manage various upper gastrointestinal conditions such as dyspepsia, gastroesophageal reflux disease (GERD), and peptic ulcer disease. However, concerns are increasing regarding their excessive and inappropriate use, particularly in cases where there is no clear medical indication. Inappropriate use can lead to unnecessary side effects and complications, emphasizing the need for better awareness of appropriate PPI use. Objectives This study aimed to assess the knowledge and attitudes of Umm Al-Qura University (UQU) students in Makkah, Saudi Arabia, regarding the inappropriate use of PPIs, highlighting the necessity of targeted educational interventions to improve awareness and promote safe PPI practices. Methods A cross-sectional online survey was conducted among 534 UQU students, aged 18-30, from both health-related and non-health-related majors. Participants were selected through convenience sampling, with the questionnaire distributed via Google Forms across various channels. Data were prepared using Microsoft Excel and analyzed with IBM SPSS Statistics for Windows, V. 25.0 (IBM Corp., Armonk, NY, USA). Results The survey revealed a significant lack of awareness about the potential side effects of PPIs, with 48.1% of participants (n=247) exhibiting low awareness, 30.9% (n=165) demonstrating high awareness, and 21% (n=112) showing moderate understanding. A chi-squared test confirmed that this awareness distribution significantly differed from what was expected, χ²(2, n=534)=60.48, p<0.001. In terms of behavior, 70.4% of participants adhered to good practices regarding PPI use, following appropriate guidelines such as using PPIs only when prescribed, following the correct dosage, and avoiding self-medication. Additionally, 21.3% (n=114) displayed moderate behavior, and 8.2% demonstrated poor behavior by engaging in practices such as using PPIs without medical supervision or not adhering to the recommended dosage and duration. A chi-squared test indicated significant differences in the behavior distribution, χ²(2, n=534)=344.14, p<0.001. Conclusion While most respondents displayed good behavior regarding PPI usage, there remains a significant gap in knowledge and attitudes. Addressing these gaps through targeted educational interventions, such as workshops, e-learning modules, and awareness campaigns, could promote the safe and effective use of PPIs among students in Saudi Arabia. The next steps would involve implementing these programs in collaboration with healthcare professionals and university departments, with effectiveness measured through follow-up surveys, behavior assessments, and analysis of PPI usage trends over time.

(1) Background: Proton pump inhibitors (PPIs) are commonly prescribed for gastric disorders. In patients with liver cirrhosis, PPI use is associated with an increased risk of spontaneous bacterial peritonitis and increased mortality rates; therefore, they should be used with caution. This study aims to evaluate the appropriateness of PPI prescriptions in hospitalized cirrhotic patients against current clinical guidelines to identify patterns of misuse and guide better prescribing practices. (2) Methods: A retrospective study was conducted on liver cirrhosis inpatients in an internal medicine department from January 2022 to May 2023. The primary measure was the proportion of PPI prescriptions aligned with clinical guidelines. Medical files were entirely reviewed by researchers to assess the appropriateness of PPI prescriptions using the current guidelines. Outcomes included the identification of common reasons for PPI prescription and the rate of inappropriate PPI use among the study population. (3) Results: The study included 189 cirrhotic patients, with PPIs prescribed to 95 (50.2%) patients during hospitalization and 75 (39.7%) patients at discharge. Among those, 47.4% of the inpatients and 34.7% at discharge had no valid indication for PPI administration. The most common reason for PPI prescription during hospital stays was gastritis, followed by antiplatelet use in high-risk patients, ulcers, and upper gastrointestinal bleeding. The most common inappropriate indication was portal hypertensive gastropathy (PHG), followed by treatment with corticosteroids and anticoagulants alone. We did not find an association between PPI administration during hospital stays and infections. Only in 4% of cases patients should have received PPIs and did not. (4) Conclusions: There is a concerning overprescription of PPIs in cirrhotic patients, often deviating from established guidelines. It subjects patients to unnecessary risks. There is an urgent need for increased awareness and adherence to clinical guidelines regarding PPI prescriptions in cirrhotic patients.

Campylobacter is a globally important pathogen with well-studied risk factors, but the burden of risk factors has not been quantified. We quantified the cost of illness attributable to specific domestic risk factors for C. jejuni and C. coli in Australia. We used data from a 2018-2019 case-control study to estimate odds ratios and attributable fractions for risk factors. We used data on national incidence, hospitalization, and premature mortality to quantify burden. We then applied costs related to healthcare utilization, pain and suffering, premature mortality, and lost productivity to each risk factor. In Australia, C. jejuni caused 83.0% of campylobacteriosis infections and chicken consumption resulted in the highest attributable fraction (30.0%), costing approximately US$110 million annually. The excess burden of campylobacteriosis associated with the use of proton-pump inhibitors (PPIs) was US$45 million, with almost half these costs due to disease in adults over 65 years of age. Contact with young dogs (US$30 million) and chicken feces (US$10 million) also contributed to costs and burden. Campylobacteriosis is a significant cost to Australia, particularly because of lost productivity. Effective cross-sectoral interventions to improve chicken meat safety and reduce inappropriate use of PPIs might have substantial economic and human benefits.

ObjectivesTo establish a clinical application monitoring system for proton pump inhibitors (PPI-MS) and to enhance the detection and intervention of inappropriate PPI use in adult hospitalised patients.MethodsNatural language processing technology...