Are Acid Reflux Drugs Overused?
Studies Suggest Many People Taking Them Don't Need Them and May Be Putting Their Health at Risk
When to Take -- and Not Take -- PPIs
The bottom line: "We have to educate patients and doctors on when and how to use PPIs," she says.
That means prescribing them only for serious conditions that occur when stomach acid escapes into the esophagus -- reflux disease and Barrett's esophagus, for example, Romero says. They're also used to prevent and treat ulcers in the small intestine and the stomach, among other conditions.
When PPIs are used, she advises doctors to use shorter courses and lower doses when possible. And just because they’re available at the local store, people shouldn't start popping the pills without telling their doctors.
"We also need to train doctors so they know it's OK to stop a PPI after it's started. Just because it’s good for them in the intensive care unit doesn’t mean they have to stay on it," Romero says.
Doctors and patients should consider other treatments for heartburn, including non-drug treatments such as stress reduction, weight loss, and smoking cessation, she says.
PPIs: the Studies
Among the new research presented at the meeting:
- In Smith's study, 204 of 358 patients (60%) were prescribed a PPI while in the hospital. The most common reason cited for prescribing a PPI was that patients were already on a PPI prior to admission.
In total, 56 patients (26%) received PPIs inappropriately while in the hospital, Smith says.
Also, 157 patients (44%) were sent home with a PPI prescription. Of these, 14 (9%) had no apparent reason to stay on PPI therapy after they were discharged, he says.
- In a Canadian study, about 70% of 125 patients were prescribed PPIs or H2RA drugs for ulcer prevention while in the intensive care unit. In nearly all cases (97%), their use was appropriate.
But about 40% were sent home from the hospital with an unnecessary prescription for the drugs. PPIs were less likely to be discontinued than H2RA drugs.
"Prescription of a proton pump inhibitor in the ICU was associated with the inappropriate prescription of the proton pump inhibitor upon hospital discharge," says study leader Jasjeet Rai, MD, of McGill University in Montreal.
- A third study involved nearly 2,000 people, of whom nearly one-third took PPIs for acid reflux.
Of these, about one-third received prescriptions from gastroenterologists, one-third received prescriptions from their primary care doctors, and the other third purchased PPIs over-the-counter without medical supervision.
About 71% of the gastroenterologists prescribed PPIs in an optimal manner. But more than half of patients receiving prescriptions from their primary care doctors and about 60% of people who bought the drugs on their own may not have needed the drugs or took them for longer than needed, the study showed.
Not surprisingly, persistent heartburn and other symptoms improved substantially more in people using PPIs optimally, compared with people taking PPIs for inappropriate reasons or excessively, say researchers from Case Western Reserve University in Cleveland.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.