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Decreasing Overall and Inappropriate Proton Pump Inhibitor Use: Perspective From a Large Safety-Net Healthcare System

Published:December 27, 2019DOI:https://doi.org/10.1016/j.cgh.2019.12.015
      Proton pump inhibitors (PPIs) have been the mainstay of treating upper gastrointestinal disorders for the past 30 years. PPI prescription rates have increased annually with recent data estimating up to 9% use in ambulatory patients.
      • Bustillos H.
      • Leer K.
      • Kitten A.
      • Reveles K.R.
      A cross-sectional study of national outpatient gastric acid suppressant prescribing in the United States between 2009 and 2015.
      This rise has led to concerns regarding appropriateness of indications, duration of use, risk of adverse drug effects, and unnecessary costs for both patients and the health system. Arguably the most debated of these concerns by the public at large seems to be the reported adverse consequences associated with chronic PPI therapy as documented in several observational studies,
      • Vaezi M.F.
      • Yang Y.X.
      • Howden C.W.
      Complications of proton pump inhibitor therapy.
      including increased enteric infections and micronutrient deficiencies.
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      Linked Article

      • Proactive Measures Aimed at Improving Appropriateness of Use of Proton Pump Inhibitors in Clinical Practice
        Clinical Gastroenterology and HepatologyVol. 19Issue 2
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          We read with great interest the article by Lin et al1 that was recently published in in Clinical Gastroenterology and Hepatology. The authors report on the impact of an educational program aimed at improving the appropriateness of proton pump inhibitors (PPIs) in a large health system in the United States.1 Indeed, we feel that the issue covered by Lin et al, despite being the topic of a long-standing clinical problem with a clear social and health impact, is still timely and relevant. For example, despite several published studies highlighting the inappropriateness of PPI prescriptions in ambulatory care,2–4 and the efforts by scientific societies both in the United States and Europe to educate physicians in the appropriate use of long-term PPIs,5,6 PPIs are still widely and inadequately prescribed in clinical practice.
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