Use and inappropriate use of proton pump inhibitors in hospitalized patients

Yadvendra Gupta, Sudhir Bhandari, Anurag Govil, Rahul Gupta, Jaswant Goyal, Barkha Goyal, Saloni Chandalia


Background: The discovery of Helicobacter pylori infection in etiology of peptic ulcer disease and proton pump inhibitors (PPI) in management of upper gastrointestinal diseases had been the milestones in medical science. PPI are currently being both overused and misused. In countries like India, where over 500 branded formulations of PPI are available, probability of misuse and abuse increases exponentially. The aim of the study was to find out inappropriate use of PPI, among hospitalized patients.

Methods: In order to find answer to the research question a cross sectional study was conducted in indoor patient of a tertiary care private hospital at Jaipur, Rajasthan. Patients of either sex, aged 18 years or above belonging to rural and urban communities were participating in study. The sample size was 500.

Results: It was noted that Inappropriate PPI use was observed in most of the hospital admitted patients (78%). Most common diagnosis among inappropriate PPI use was dengue fever (due to increased number of dengue cases during study period), followed by cerebrovascular accidents and urinary tract infection. Most common indication for appropriate PPI use was stress ulcer prophylaxis, again in dengue case (due to cardinal manifestation of thrombocytopenia).

Conclusions: Almost all patients were once prescribed PPI after admission and discharged on PPI (99.2%). Thus, we recommend evidence-based prescription of PPI, to reduce side effects and excess cost.


PPI, Gastrointestinal diseases, Hospitalized patients, Dengue fever

Full Text:



Khalili H, Huang ES, Jacobson BC, Carmargo CA, Feskanich D, Chan AT. Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. BMJ. 2012;344:e372.

Wallace LJ, Sharkey KA. Goodman Gilman’s The pharmacological basis of therapeutics. In: Brunton LL, Hilal-Dandan R, Knollmann BC, eds. 12 ed. 2011; 45: 1309-1322.

Freston J, Chiu YL, Pan WJ, Lukasik N, Taubel J. Oral bioavailability of pantoprazole suspended in sodium bicarbonate solution. Am J Health Sys Pharm. 2003;60:1324-9.

Dickson EJ, Stuart RC. Genetics of response to proton pump inhibitor therapy: clinical implications. Am J Pharmacogenomics. 2003;3:303-15.

Chong E, Ensom MH. Pharmacogenetics of the proton pump inhibitors: a systematic review. Pharmacotherap. 2003;23:460-71.

Wang C, Hunt RH. Medical management of gastroesophageal reflux disease. Gastroenterol Clin North Am. 2008;37:879-99.

Ray S, Delaney M, Muller AF. Proton pump inhibitors and acute interstitial nephritis. BMJ. 2010;341:668-70.

Andres E, Loukili N, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ. 2004;171:251-9.

Howden CW. Vitamin B12 levels during prolonged treatment with proton pump inhibitors. J Clin Gastroenterol. 2000;30:29-33.

Valuck RJ, Ruscin JM. A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B12 deficiency in older adults. J Clin Epidemiol. 2004;57:422-8.

Den Elzen WP, Groeneveld Y, De Ruijter W, Souverijn JH, Le Cessie S, Assendelft WJ, et al. Long-term use of proton pump inhibitors and vitamin B12 status in elderly individuals. Aliment Pharmacol Ther. 2008;27:491-7.

Stewart CA, Termanini B, Sutliff VE, Serrano J, Yu F, Gibril F, et al. Iron absorption in patients with Zollinger-Ellison syndrome treated with long-term gastric acid antisecretory therapy. Aliment Pharmacol Ther. 1998;12:83-98.

Sheen E, Triadafilopoulos G. Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci. 2011;56:931-50.

Howden CW, Hunt RH. Relationship between gastric secretion and infection. Gut. 1987;28:96-107.

Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol. 2007;102:2047-56.

Thachil J. Overprescribing PPIs: time for a hospital antacid policy on Clostridium difficile. BMJ. 2008;336:109.

Metz DC. Clostridium difficile colitis: wash your hands before stopping the proton pump inhibitor. Am J Gastroenterol. 2008;103:2314-6.

Thomson AB, Sauve MD, Kassam N, Kamitakahara H. Safety of the long-term use of proton pump inhibitors. World J Gastroenterol. 2010;16(19):2323-30.

Johnson DA. Safety of proton pump inhibitors: current evidence for osteoporosis and interaction with antiplatelet agents. Curr Gastroenterol Rep. 2010;12(3):167-74.

Tepes B. Long-term acid inhibition: benefits and harms. Dig Dis. 2011;29(5):476-81.

O’Donoghue ML, Braunwald E, Antman EM, Murphy SA, Bates ER, Rozenman Y, et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. Lancet. 2009;374(9694):989-97.

Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Leslie WD. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ. 2008;179(4):319-26.

Kinoshita Y, Ishimura N, Ishihara S. Advantages and disadvantages of long-term proton pump inhibitors use. J Neurogastroenterol Motil. 2018;24(2):182 -96.

Vaezi MF, Yang YX, Howden CW. Reviews in Basic and Clinical Gateroenterology and Hepatology: Complications of Proton Pump Inhibitor Therapy. Gasteroenterol. 2017;153:35-48.

Moayyedi P, Delaney BC, Vakil N, Forman D, Talley NJ. The efficacy of proton pump inhibitors in nonulcer dyspepsia: a systematic review and economic analysis. Gastroenterol. 2004;127(5):1329-37.

Donnellan C, Sharma N, Preston C, Moayyedi P. Medical treatments for the maintenance therapy of reflux oesophagitis and endoscopic negative reflux disease. Cochrane Database Syst Rev. 2005;2:CD003245.

Lundell L, Attwood S, Ell C, Fiocca R, Galmiche JP, Hatlebakk J, et al. Comparing laparoscopic antireflux surgery with esomeprazole in the management of patients with chronic gastro-oesophageal reflux disease: a 3-year interim analysis of the Lotus trial. Gut. 2008;57(9):1207-13.

Edwards SJ, Lind T, Lundell L, Das R. Systematic review: standard- and double-dose proton pump inhibitors for the healing of severe erosive oesophagitis- a mixed treatment comparison of randomized controlled trials. Aliment Pharmacol Ther. 2009;30(6):547-56.

Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA. 2001;285(18):2331-8.

Ahrens D, Chenot JF, Behrens G, Grimmsmann T, Kochen MM. Appropriateness of treatment recommendations for PPI in hospital discharge letters. Eur J Clin Pharmacol. 2010;66(12):1265-71.