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Inappropriate prescription of proton pump inhibitors on two pulmonary medicine wards

van Vliet, Evelyn P.M.a; Otten, Henk J.A.M.b; Rudolphus, Arjand; Knoester, Pieter D.c; Hoogsteden, Henk C.b; Kuipers, Ernst J.a; Siersema, Peter D.a

European Journal of Gastroenterology & Hepatology: July 2008 - Volume 20 - Issue 7 - p 608-612
doi: 10.1097/MEG.0b013e3282f52f95
Original Articles: Oesophageal and Gastric Disorders

Objective We recently noticed that proton pump inhibitor (PPI) use was high on a pulmonary medicine ward of a university clinic and reasons for this high usage were not clear. Our aim was to determine the indications for PPI use on two pulmonary medicine wards and to assess whether this use was appropriate.

Methods We assessed prospectively the number of patients on PPIs and the indications for PPI use on two pulmonary medicine wards, one from a university and one from a regional clinic in The Netherlands.

Results On admission, 88 of 300 (29%) patients already used PPIs. The use of PPIs was discontinued in three (1%) patients, whereas PPIs were initiated in 45 (15%) patients, resulting in 130 (43%) patients on PPIs during hospitalization. The most common indication for PPI use was the prevention of medication-associated complications. In 78 of 130 (60%) patients on PPIs, this medication was used for a registered indication, whereas in 52 (40%) patients a registered indication was not present (overuse). In contrast, 19 of 300 (6%) patients were not prescribed PPIs despite the presence of a registered indication for its use (underuse). No differences were found in prescription rate and indications for PPI use between the university and the regional clinic.

Conclusion PPI use was very common on two pulmonary medicine wards in the Netherlands. Forty percent of the patients used their PPIs for a nonregistered indication. As use of PPIs is costly and may be associated with side effects, hospital physicians should to be better educated on guidelines for its use.

Departments of aGastroenterology and Hepatology

bPulmonary Medicine

cClinical Pharmacy, Erasmus MC-University Medical Center Rotterdam

dDepartment of Pulmonary Medicine, Sint Franciscus Gasthuis Rotterdam, The Netherlands

Correspondence to Evelyn P.M. van Vliet, Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

Tel: +31 10 4634681; fax: +31 10 4634682;


These data were presented in part at the autumn meeting of the Dutch Society of Gastroenterology, Veldhoven, The Netherlands in 2005 and at the Digestive Disease Week, Los Angeles, USA in 2006 (Gastroenterology 2006; 130:A174).

Received 22 September 2007 Accepted 5 December 2007

© 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins