Ferguson, H.R.; Loo, B.E.; Varghese, A.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA80
Academic Journal
Introduction: Millions of pounds are spent each year in the NHS on prescribing PPIs for dyspepsia. The National Institute for Clinical Excellence (NICE) produced guidance on the use of PPIs in July 2000 to improve clinical practice and cost effectiveness. Aim: To establish current practice in prescribing PPIs. Methods: We identified medical admissions over a 2 week period in September 2002. The charts of those patients on PPIs were reviewed and data collected. Results: 91 patients were admitted of which 40 (44%) were on a PPI. In this group the average age was 71.2 years (range 41-96 years). 65% were male. The average length of therapy was 128 weeks (range 1-624 weeks). In 25 (62%) there was a clear indication for PPI use (recently diagnosed peptic ulcer, previous ulcer on NSAID, dyspepsia) but in 15 (38%) there was no compelling indication (NSAID with no peptic ulcer disease, alcohol abuse, on clopidogrel). 22 patients (55%) were on healing doses of PPI. In 6 (15%) this was for an appropriate reason (active peptic ulcer, uncontrolled reflux symptoms). 16 patients (40%) were prescribed inappropriately high doses (NSAID prophylaxis, controlled dyspepsia with no attempt made to reduce to maintainance doses). 22 patients (55%) had previous upper Gl endoscopy, 10 (25%) were unfit for investigation, 1 (2%) had not attended, 7(18%) were suitable but had no previous investigations performed. 12 patients had a diagnosis of gastritis, duodenitis or peptic ulcer disease made at endoscopy. Of these 2 were not tested for Helicobacter pylori infection. Conclusion: A substantial proportion of patients were prescribed PPI therapy with no clear indication, or in inappropriately high doses. 7 patients were on long term PPIs without a confirmed clinical diagnosis, and 2 with possible H pylori associated pathology were not tested. The NICE guidance on the use of PPIs is not followed in clinical practice.


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