In a study including several million veterans as participants, researchers at the University of Michigan found that an intervention that reduced the number of proton pump inhibitors (PPIs) prescribed did not lead to an increase in acid-related diseases encountered, suggesting that PPIs are overprescribed.
PPIs are drugs used to reduce stomach acid and are among the top 10 most prescribed drugs in the US. Common brand names include omeprazole, lansoprazole, and pantoprazole. They reduce stomach acid by blocking the effects of an enzyme known as the proton pump, or the H+/K+ ATPase enzyme, in the parietal cells of the stomach and are considered the most powerful of the antacids. They're commonly prescribed to treat inflammation of the esophagus, reflux disease, peptic ulcer disease, and as a preventative of GI bleeds in patients on NSAIDs and blood thinners.
Adverse effects include low magnesium levels, vitamin B12 deficiency, and iron deficiency. Low magnesium can lead to muscle spasms, weakness, seizures, delirium, and cardiac arrhythmias. PPIs may also lead to an increase in GI infections, such as C. difficile, due to changes to the acid barrier. Other potential adverse effects include osteoporosis and stomach polyps.
The intervention in this study included deprescribing efforts through patient and clinician education. Investigators analyzed the number of veterans taking PPIs; the proportion of hospitalizations for upper GI diseases; and rates of primary care visits, gastroenterology visits, and EGD procedures, which image the upper GI tract, before and after the deprescribing intervention. The study found no significant increase in MD visits or hospitalization rates for upper GI diseases after PPI use reduction.
Of note, researchers cautioned that this intervention to reduce overprescribing of PPIs also reduced appropriate prescription in some cases.