Review on Effective Use of Proton Pump Inhibitors in Clinical Practice
Abstract
Proton pump inhibitors (PPIs), which are powerful inhibitors of gastric acid secretion, are invaluable in the treatment of acid-related disorders but their extensive and sometimes prolonged use creates concerns about patient safety and the utilization of healthcare resources. This review integrates current evidence and guidelines to overcome the problems with inappropriate use of PPIs. It emphasizes the need for patient-related strategies, such as careful clinical evaluation and compliance with evidence-based guidelines, to best optimize PPI therapy. Strategies like deprescribing protocols, patient education, and prescription audits are brought to the advance to counteract the risks of long-term PPI use. In addition, the need to create and execute context-specific guidelines, along with concerted efforts by healthcare teams, is emphasized to promote judicious use of PPIs and enhance patient outcomes.
Keywords:
Proton Pump Inhibitors (PPIs), Inappropriate Use of PPIs, Deprescribing, Acid-Related Disorders, Clinical Guidelines, Long-Term PPI Use
References
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11. Savarino, Edoardo, et al. “Holistic Management of Symptomatic Reflux: Rising to the Challenge of Proton Pump Inhibitor Overuse.” British Journal of General Practice, vol. 72, no. 724, Nov. 2022, pp. 541–44. DOI.org (Crossref), https://doi.org/10.3399/bjgp22X721157.
12. Vakil, Nimish, et al. “The Montreal Definition and Classification of Gastroesophageal Reflux Disease: A Global Evidence-Based Consensus.” The American Journal of Gastroenterology, vol. 101, no. 8, Aug. 2006, pp. 1900–20. DOI.org (Crossref), https://doi.org/10.1111/j.1572-0241.2006.00630.x.
13. Kahrilas, Peter, et al. “Proton Pump Inhibitors: Rational Use and Use-Reduction – The Windsor Workshop.” Digestive Diseases (Basel, Switzerland), vol. 42, no. 3, Mar. 2024, pp. 211–20. PubMed Central, https://doi.org/10.1159/000538399.
14. Aubert, Geraldine, and Peter M. Lansdorp. “Telomeres and Aging.” Physiological Reviews, vol. 88, no. 2, Apr. 2008, pp. 557–79. DOI.org (Crossref), https://doi.org/10.1152/physrev.00026.2007.
15. Gunturu LN, Pamayyagari K, Dornadula GR. A Case Report on Herpes Zoster Eruption Associated with Chronic Obstructive Pulmonary Disease. International Journal of Therapeutic Applications, Volume 37, 2020.
16. Katz, Philip O., et al. “Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease.” American Journal of Gastroenterology, vol. 108, no. 3, Mar. 2013, pp. 308–28. DOI.org (Crossref), https://doi.org/10.1038/ajg.2012.444.
17. Chandra J, Venkatesh P. Review on prevalence of OTC medications. International Journal of Health Care and Biological Sciences. 2022 Jan 23:12-4.
18. Cook, D. J., et al. “Stress Ulcer Prophylaxis in the Critically Ill: A Meta-Analysis.” The American Journal of Medicine, vol. 91, no. 5, Nov. 1991, pp. 519–27. PubMed, https://doi.org/10.1016/0002-9343(91)90189-5.
19. Whitcomb, David C., et al. “Angiopoietin-2, a Regulator of Vascular Permeability in Inflammation, Is Associated With Persistent Organ Failure in Patients With Acute Pancreatitis From the United States and Germany.” American Journal of Gastroenterology, vol. 105, no. 10, Oct. 2010, pp. 2287–92. DOI.org (Crossref), https://doi.org/10.1038/ajg.2010.183.
20. Freedberg, Daniel E., et al. “The Risks and Benefits of Long-Term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association.” Gastroenterology, vol. 152, no. 4, Mar. 2017, pp. 706–15. DOI.org (Crossref), https://doi.org/10.1053/j.gastro.2017.01.031.
21. Savarino, Vincenzo, et al. “The Appropriate Use of Proton-Pump Inhibitors.” Minerva Medica, vol. 109, no. 5, Oct. 2018, pp. 386–99. PubMed, https://doi.org/10.23736/S0026-4806.18.05705-1.
22. Rakowska M, Brzósko S, Dąbrowska E, Jabłońska E, Szczykowska J, Prusator P, et al. Using proton-pump inhibitors among hemodialysis patients - single academic dialysis center’s preliminary experience. Progress in Health Sciences [Internet]. 2017 Jul 14 [cited 2025 Mar 28];7(1):39–43. Available from: https://www.umb.edu.pl/photo/pliki/progress-file/phs
23. Susmitha N, Venkatesh P. Review on infectious diseases. International Journal of Indigenous Herbs and Drugs. 2022 Jan 30:18-21.
24. Ladd, Antonio Mendoza, et al. “Potential Costs of Inappropriate Use of Proton Pump Inhibitors.” The American Journal of the Medical Sciences, vol. 347, no. 6, June 2014, pp. 446–51. DOI.org (Crossref), https://doi.org/10.1097/MAJ.0b013e31829f87d5.
25. Narasimha GL, Dornadula GR. A Case Report on Pleural Effusion Induced by Pulmonary Tuberculosis Reactivation. International Journal of Science and Research (IJSR) ISSN: 2319-7064, Volume 8 Issue 8, August 2019.
26. Afshan, Anjum. “Rationale Use of Proton Pump Inhibitors: Observational Study of Hospital Based Prescriptions and Role of Clinical Pharmacist.” Pakistan Journal of Pharmaceutical Sciences, vol. 31, no. 4, July 2018, pp. 1217–27.
27. Switzer, Julie A., and Mary I. O’Connor. “AAOS Management of Hip Fractures in Older Adults Evidence-Based Clinical Practice Guideline.” Journal of the American Academy of Orthopaedic Surgeons, vol. 30, no. 20, Oct. 2022, pp. e1297–301. DOI.org (Crossref), https://doi.org/10.5435/JAAOS-D-22-00273.
28. Ladd, Antonio Mendoza, et al. “Potential Costs of Inappropriate Use of Proton Pump Inhibitors.” The American Journal of the Medical Sciences, vol. 347, no. 6, June 2014, pp. 446–51. PubMed, https://doi.org/10.1097/MAJ.0b013e31829f87d5.
29. Afshan, Anjum. “Rationale Use of Proton Pump Inhibitors: Observational Study of Hospital Based Prescriptions and Role of Clinical Pharmacist.” Pakistan Journal of Pharmaceutical Sciences, vol. 31, no. 4, July 2018, pp. 1217–27.
2. Aubert, Geraldine, and Peter M. Lansdorp. “Telomeres and Aging.” Physiological Reviews, vol. 88, no. 2, Apr. 2008, pp. 557–79. DOI.org (Crossref), https://doi.org/10.1152/physrev.00026.2007.
3. Freedberg, Daniel E., et al. “The Risks and Benefits of Long-Term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association.” Gastroenterology, vol. 152, no. 4, Mar. 2017, pp. 706–15. DOI.org (Crossref), https://doi.org/10.1053/j.gastro.2017.01.031.
4. Rao, Rajesh C., and Lynn J. Poole Perry. “Decreased Vision Following Eye Trauma.” JAMA, vol. 306, no. 23, Dec. 2011, p. 2606. DOI.org (Crossref), https://doi.org/10.1001/jama.2011.1832.
5. Vakil, Nimish, et al. “The Montreal Definition and Classification of Gastroesophageal Reflux Disease: A Global Evidence-Based Consensus.” The American Journal of Gastroenterology, vol. 101, no. 8, Aug. 2006, pp. 1900–20. DOI.org (Crossref), https://doi.org/10.1111/j.1572-0241.2006.00630.x.
6. Farrell, Barbara, et al. “Deprescribing Proton Pump Inhibitors: Evidence-Based Clinical Practice Guideline.” Canadian Family Physician Medecin De Famille Canadien, vol. 63, no. 5, May 2017, pp. 354–64.
7. Targownik, Laura E., et al. “AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review.” Gastroenterology, vol. 162, no. 4, Apr. 2022, pp. 1334–42. PubMed, https://doi.org/10.1053/j.gastro.2021.12.247.
8. Savarino, Vincenzo, et al. “The Appropriate Use of Proton-Pump Inhibitors.” Minerva Medica, vol. 109, no. 5, Oct. 2018, pp. 386–99. PubMed, https://doi.org/10.23736/S0026-4806.18.05705-1.
9. Dharmarajan, Thiruvinvamalai S. “The Use and Misuse of Proton Pump Inhibitors: An Opportunity for Deprescribing.” Journal of the American Medical Directors Association, vol. 22, no. 1, Jan. 2021, pp. 15–22. DOI.org (Crossref), https://doi.org/10.1016/j.jamda.2020.09.046.
10. Heidelbaugh, Joel J., et al. “Overutilization of Proton-Pump Inhibitors: What the Clinician Needs to Know.” Therapeutic Advances in Gastroenterology, vol. 5, no. 4, July 2012, pp. 219–32. DOI.org (Crossref), https://doi.org/10.1177/1756283X12437358.
11. Savarino, Edoardo, et al. “Holistic Management of Symptomatic Reflux: Rising to the Challenge of Proton Pump Inhibitor Overuse.” British Journal of General Practice, vol. 72, no. 724, Nov. 2022, pp. 541–44. DOI.org (Crossref), https://doi.org/10.3399/bjgp22X721157.
12. Vakil, Nimish, et al. “The Montreal Definition and Classification of Gastroesophageal Reflux Disease: A Global Evidence-Based Consensus.” The American Journal of Gastroenterology, vol. 101, no. 8, Aug. 2006, pp. 1900–20. DOI.org (Crossref), https://doi.org/10.1111/j.1572-0241.2006.00630.x.
13. Kahrilas, Peter, et al. “Proton Pump Inhibitors: Rational Use and Use-Reduction – The Windsor Workshop.” Digestive Diseases (Basel, Switzerland), vol. 42, no. 3, Mar. 2024, pp. 211–20. PubMed Central, https://doi.org/10.1159/000538399.
14. Aubert, Geraldine, and Peter M. Lansdorp. “Telomeres and Aging.” Physiological Reviews, vol. 88, no. 2, Apr. 2008, pp. 557–79. DOI.org (Crossref), https://doi.org/10.1152/physrev.00026.2007.
15. Gunturu LN, Pamayyagari K, Dornadula GR. A Case Report on Herpes Zoster Eruption Associated with Chronic Obstructive Pulmonary Disease. International Journal of Therapeutic Applications, Volume 37, 2020.
16. Katz, Philip O., et al. “Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease.” American Journal of Gastroenterology, vol. 108, no. 3, Mar. 2013, pp. 308–28. DOI.org (Crossref), https://doi.org/10.1038/ajg.2012.444.
17. Chandra J, Venkatesh P. Review on prevalence of OTC medications. International Journal of Health Care and Biological Sciences. 2022 Jan 23:12-4.
18. Cook, D. J., et al. “Stress Ulcer Prophylaxis in the Critically Ill: A Meta-Analysis.” The American Journal of Medicine, vol. 91, no. 5, Nov. 1991, pp. 519–27. PubMed, https://doi.org/10.1016/0002-9343(91)90189-5.
19. Whitcomb, David C., et al. “Angiopoietin-2, a Regulator of Vascular Permeability in Inflammation, Is Associated With Persistent Organ Failure in Patients With Acute Pancreatitis From the United States and Germany.” American Journal of Gastroenterology, vol. 105, no. 10, Oct. 2010, pp. 2287–92. DOI.org (Crossref), https://doi.org/10.1038/ajg.2010.183.
20. Freedberg, Daniel E., et al. “The Risks and Benefits of Long-Term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association.” Gastroenterology, vol. 152, no. 4, Mar. 2017, pp. 706–15. DOI.org (Crossref), https://doi.org/10.1053/j.gastro.2017.01.031.
21. Savarino, Vincenzo, et al. “The Appropriate Use of Proton-Pump Inhibitors.” Minerva Medica, vol. 109, no. 5, Oct. 2018, pp. 386–99. PubMed, https://doi.org/10.23736/S0026-4806.18.05705-1.
22. Rakowska M, Brzósko S, Dąbrowska E, Jabłońska E, Szczykowska J, Prusator P, et al. Using proton-pump inhibitors among hemodialysis patients - single academic dialysis center’s preliminary experience. Progress in Health Sciences [Internet]. 2017 Jul 14 [cited 2025 Mar 28];7(1):39–43. Available from: https://www.umb.edu.pl/photo/pliki/progress-file/phs
23. Susmitha N, Venkatesh P. Review on infectious diseases. International Journal of Indigenous Herbs and Drugs. 2022 Jan 30:18-21.
24. Ladd, Antonio Mendoza, et al. “Potential Costs of Inappropriate Use of Proton Pump Inhibitors.” The American Journal of the Medical Sciences, vol. 347, no. 6, June 2014, pp. 446–51. DOI.org (Crossref), https://doi.org/10.1097/MAJ.0b013e31829f87d5.
25. Narasimha GL, Dornadula GR. A Case Report on Pleural Effusion Induced by Pulmonary Tuberculosis Reactivation. International Journal of Science and Research (IJSR) ISSN: 2319-7064, Volume 8 Issue 8, August 2019.
26. Afshan, Anjum. “Rationale Use of Proton Pump Inhibitors: Observational Study of Hospital Based Prescriptions and Role of Clinical Pharmacist.” Pakistan Journal of Pharmaceutical Sciences, vol. 31, no. 4, July 2018, pp. 1217–27.
27. Switzer, Julie A., and Mary I. O’Connor. “AAOS Management of Hip Fractures in Older Adults Evidence-Based Clinical Practice Guideline.” Journal of the American Academy of Orthopaedic Surgeons, vol. 30, no. 20, Oct. 2022, pp. e1297–301. DOI.org (Crossref), https://doi.org/10.5435/JAAOS-D-22-00273.
28. Ladd, Antonio Mendoza, et al. “Potential Costs of Inappropriate Use of Proton Pump Inhibitors.” The American Journal of the Medical Sciences, vol. 347, no. 6, June 2014, pp. 446–51. PubMed, https://doi.org/10.1097/MAJ.0b013e31829f87d5.
29. Afshan, Anjum. “Rationale Use of Proton Pump Inhibitors: Observational Study of Hospital Based Prescriptions and Role of Clinical Pharmacist.” Pakistan Journal of Pharmaceutical Sciences, vol. 31, no. 4, July 2018, pp. 1217–27.
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S, S. K. (2025). Review on Effective Use of Proton Pump Inhibitors in Clinical Practice . Journal of Integral Sciences, 8(2), 37-42. https://doi.org/10.37022/jis.v7i2.128
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