Proton Pump Inhibitor Therapy

( Last Updated : August 29, 2010)
Project Line:
Health Technology Review



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.


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.


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.


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


The Canadian Agency for Drugs and Technologies in Health (CADTH) assists health care providers, decision- makers, and consumers with the local implementation of optimal drug therapy, including the use of proton pump inhibitors (PPIs) — a class of medications used to treat common gastrointestinal (GI) conditions. We do this by offering intervention tools based on our evidence-based clinical and cost-effectiveness information (detailed in our Optimal Therapy Reports), which you can access to help implement optimal PPI therapy in your area. Contact us if you would like our assistance in tailoring any of these tools to meet your unique needs.

To help decision-makers evaluate optimal therapy initiatives, CADTH has also developed a series of generic tools that can be applied across health topics. These generic tools including an audit and feedback guide, an evaluation framework, and academic detailing templates.

PPI Tools

Project Status

Represents current activity
in project process


To assist health care providers, policy-makers, and consumers in making well-informed decisions about the prescribing and use of proton pump inhibitors, our completed research and resulting recommendations are available in a series of Optimal Therapy Reports that provide:

  • evidence-based clinical statements and cost-effectiveness statements
  • a clear picture of current practice and current utilization in Canada
  • an analysis of the quantity of proton pump inhibitor agents prescribed, including market share and cost information
  • an outline of gaps between current prescribing and use.

Summary Reports

Final Reports