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Proton Pump Inhibitor Therapy

Medication

Proton pump inhibitors (PPIs) are a class of medications used to treat common gastrointestinal (GI) conditions.

Need for Recommendations

 PPIs are commonly prescribed and widely used in Canada, with 12.4 million PPI prescriptions dispensed in 2004. However, questions exist about whether PPIs are being prescribed and used appropriately. Both over- and under-usage of PPIs have been reported, and costs associated with inappropriate prescribing and use may be considerable. To optimize the prescribing and use of PPIs in Canada, the evidence needed to be examined and the results communicated effectively to policy- makers, prescribers, and consumers.

Methods

CADTH was directed by the federal, provincial, and territorial (F/P/T) governments to focus on the optimal use of PPIs in Canada. CADTH conducted this project under its former Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) program. CADTH undertook a multi-step process to:

  • identify, summarize, and evaluate the clinical evidence in the form of evidence-based statements
  • produce reliable economic evidence
  • understand the current practice, in Canada, related to PPI prescribing and use
  • identify gaps in practice, highlighting areas where current practice differs from the evidence
  • develop key messages based on the evidence-based statements to address the gaps in practice
  • select interventions to support the key messages and effect change in the prescribing and use of PPIs
  • develop intervention tools for implementation
  • develop an evaluation framework.

Results

The CADTH PPI project has resulted in:

  • 52 evidence-based statements
    • 28 relating to gastroesophageal reflux disease (GERD)
    • 6 relating to dyspepsia
    • 18 relating to peptic ulcer disease (PUD)
  • three key gaps in current PPI prescribing and use, as compared with the evidence
  • three primary, and eight additional, key messages important to policy-makers and prescribers
  • twelve intervention tools ready for implementation to effect change in PPI prescribing and use, and a framework to assist in their evaluation
  • nine Optimal Therapy Reports on PPIs.

Key Messages

  • All PPIs are equally efficacious in the initial treatment of GERD, dyspepsia, and other common GI conditions.
  • Doubling the standard daily doses of PPIs, as initial therapy, is no better than standard daily-dose therapy.
  • PPIs are not efficacious in treating cough, asthma, or laryngeal symptoms associated with GERD.

Key Outcomes

Through the uptake and adoption of the CADTH PPI key findings:

  • Health outcomes can be improved
  • Limited health care resources can be targeted more effectively.

Condition

CADTH addressed the use of PPIs for the management of GERD, dyspepsia, PUD, Helicobacter pylori infection, and nonsteroidal anti-inflammatory drug-associated ulcer.