VIDEO: Barriers to PPI gastroprotection lead to underutilization among providers

Adrienna Jirik, MD

Starting PPIs is almost a clinical knee-jerk response to patients complaining of any gastroesophageal reflux symptoms or epigastric pain or being admitted to the hospital with GI bleeding from peptic ulcer disease. It is a rare occurrence where I will peruse a patient’s medication list and not see a PPI. With that being said, by the time a patient has seen any of my GI colleagues or myself in the office or in the hospital, most would have already had symptoms to initiate PPI therapy. 

For secondary protection of gastroduodenal toxicity causing upper GI bleeding in patients considered high risk — those on long-term aspirin use with or without concomitant use of other antiplatelet therapies, NSAIDs, anticoagulants and steroids — Kurlander’s study suggests PPI underutilization among physicians most likely involved in a patient’s care who take any of the above medications. Although the study was limited to interviewing several physicians within each specialty of primary care, gastroenterology, cardiology and vascular surgery, I found the study quite revealing. It highlights the need to not only disperse current secondary prevention guidelines to those prescribing these medications, but also to further clarify provider concerns about reported adverse effects of PPIs as a barrier to starting PPI prophylaxis.

It would be interesting to see a larger scale study of provider practices — including transplant physicians, rheumatologists, neurologists and pain management specialists — to quantify the degree of PPI underutilization for gastroprotection for those who are high risk.