Physicians inappropriately favor discontinuing PPIs in high risk upper GI bleeding cases
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Survey results revealed most internists perceived proton pump inhibitors were linked with numerous adverse events and recommended their discontinuation even in patients who are high risk for upper gastrointestinal bleeding.
“Recent professional recommendations have put a lot of emphasis on using PPIs more restrictively and stopping them in patients who may not need them,” Jacob E. Kurlander, MD, MS, assistant professor at the University of Michigan and associate investigator at the Veterans Affairs Center for Clinical Management Research, told Healio Gastroenterology and Liver Disease. “So, for patients on PPIs, physicians have to ask themselves, can this patient stop the drug? When answering this question, we found that most physicians would recommend stopping the drug in a circumstance where doing so could be harmful — when it’s used for the prevention of gastrointestinal bleeding.”
He added, “We found that physicians believe PPIs carry a substantial risk of side effects and have received the message that they should be cutting back on the use of PPIs. However, they may also be overlooking an important benefit of these drugs, which is the prevention of gastrointestinal bleeding in patients at risk. PPIs are very effective for this.”
Kurlander and colleagues asked 799 internists to complete an online survey on perceptions of PPI adverse effects and effectiveness for upper GI bleeding prevention, changes in prescribing and management recommendations for patients using PPIs for GERD or upper GI bleeding prevention. There were 437 total responses. Investigators determined factors correlated with appropriate PPI continuation in patients at high risk for upper GI bleeding with logistic regression.
Results showed 70% of respondents were somewhat/very concerned about PPI adverse events and 76% had somewhat/very much changed their prescribing. Most respondents perceived PPIs increased the risk for six of 12 adverse events examined. Investigators noted 52% of respondents said PPIs were somewhat/every effective for the prevention of upper GI bleeding.
In a scenario where PPIs can be safely discontinued for GERD, 86% of respondents appropriately recommended discontinuation. In contrast, in a high-risk upper GI bleeding prevention scenario where long-term use of PPI is recommended, 79% of respondents inappropriately recommended discontinuation. Further, the perceived effectiveness for bleeding prevention was significantly correlated with PPI continuation (OR 7.68, P < .001 for moderately effective; OR 17.3, P <.001 for very effective). There was no correlation noted in other covariates such as PPI adverse events.
“In patients who have a high risk of bleeding, related to factors such a history of ulcers, or use of aspirin, NSAIDs or blood thinners, PPIs can dramatically reduce the risk of gastrointestinal bleeding,” Kurlander said. “This is a decision physicians need to think carefully about. In addition, interventions are needed to help physicians choose the right patients to treat with PPIs.” – by Monica Jaramillo
Disclosure: Kurlander reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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