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Patients' Perceptions of Proton Pump Inhibitor Risks and Attempts at Discontinuation

A National Survey

Kurlander, Jacob E., MD, MS1,2,3; Kennedy, Jennifer K., MD2; Rubenstein, Joel H., MD, MS2,3,4; Richardson, Caroline R., MD3,5; Krein, Sarah L., PhD2,3,4; De Vries, Raymond3,6,7; Saini, Sameer D., MD, MS2,3,4

American Journal of Gastroenterology: February 2019 - Volume 114 - Issue 2 - p 244–249
doi: 10.14309/ajg.0000000000000061

OBJECTIVES: Little is known about how reports on the adverse effects of proton pump inhibitors (PPIs) impact patients' perceptions of these drugs and medication use. We sought to determine patients' level of concern about PPI adverse effects and its association with attempts to discontinue these drugs.

METHODS: This study is an online survey of US adults who use PPIs for gastroesophageal reflux disease. Topics included awareness of and concern about PPI adverse effects, prior discussion with providers, and attempts to stop PPI because of concern about adverse effects. For the primary analysis, we used logistic regression to identify associations between having attempted to stop PPI and concern about PPI-related adverse effects, a provider's recommendation to stop, risk of upper gastrointestinal bleeding (UGIB), age, and gender.

RESULTS: Among 755 patient participants, mean age was 49 years (s.d. 16), 71% were women, and 24% were at high risk of UGIB. Twenty percent of patients were able to write in ≥1 reported adverse effect, and 46% endorsed awareness of ≥1 adverse effect when presented with a list, most commonly chronic kidney disease (17%). Thirty-three percent of patients were slightly concerned, 32% somewhat concerned, and 14% extremely concerned about adverse effects. Twenty-four percent of patients had discussed PPI risks and benefits with a provider, and 9% had been recommended to stop. Thirty-nine percent had attempted to stop their PPI, most (83%) without a provider recommendation. Factors associated with an attempt at stopping PPI included: (i) provider recommendation to stop (odds ratio [OR] 3.26 [1.82–5.83]); (ii) concern about adverse effects (OR 5.13 [2.77–9.51] for slightly, 12.0 [6.51–22.2] for somewhat, and 19.4 [9.75–38.7] for extremely concerned); and (iii) female gender (OR 1.64 [1.12–2.39]). Patients at high risk of UGIB were as likely to have attempted to stop as others (OR 0.98 [0.66–1.44]).

CONCLUSIONS: Concern about PPIs is common and strongly associated with attempts at discontinuation, even without a provider's recommendation. Notably, individuals at high risk of UGIB, who benefit from PPIs, were equally likely to have tried stopping PPIs as others. Providers should proactively discuss the risks and benefits of PPIs with their patients, who may otherwise make unwise decisions about PPI management on their own.

1VA Ann Arbor Healthcare System, Ann Arbor, MI;

2Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan;

3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan;

4Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan;

5Department of Family Medicine, University of Michigan, Ann Arbor, Michigan;

6Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan;

7Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan.

Correspondence: Jacob E. Kurlander, MD, MS. E-mail:

SUPPLEMENTARY MATERIAL accompanies this paper at

The first two authors are co-primary authors.

Received June 21, 2018

Accepted November 08, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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