Intravenous proton pump inhibition utilization and prescribing patterns escalation: a comparison between early and current trends in use

Background

Approved indications of intravenous (IV) proton pump inhibition (PPI) are limited to treatment of reflux esophagitis in patients unable to tolerate oral medications and for patients with pathologic hypersecretory states.

Objectives

IV PPIs are commonly used after endoscopic evaluation of patients with high-risk endoscopic stigmata (HRES) of nonvariceal upper GI bleeding (NVUGIB). There appears to have been an expansion of indications of this drug at many centers.

Design

All consecutive patients receiving IV PPI (pantoprazole) between 2 study periods, (1) when pantoprazole was restricted to the gastroenterology service and (2) when it was unrestricted, were reviewed.

Setting

Tertiary care university hospital.

Patients

All receiving IV PPI.

Interventions

IV PPI utilization.

Main Outcome Measurements

Percentage of patients receiving IV PPI for indications other than bleeding during 2 time periods.

Results

In the early period, 217 patients (67.30% male) received IV PPI on 218 occasions compared with 516 patients (65.31% male, P = .61) in the later period on 613 occasions. In the early group, 93.12% of 217 patients received IV PPI for NVUGIB compared with 56.12% of 516 patients (P < .0001) with 18% of patients receiving IV PPI for nothing by mouth status and 13% for abdominal pain in the later group. A total of 153 (70.18%) patients in the early group underwent upper endoscopy compared with only 275 (44.86%) patients in the later group; 84 of these 153 patients (54.90%) were already on IV PPI at the time of endoscopy in the early group compared with 253 (92.00%, P < .0001).

Conclusions

IV PPI use has escalated at our hospital and is being prescribed in patients before endoscopy with fewer patients noted to have HRES on endoscopy.

Abbreviations: HRES, high-risk endoscopic stigmata, ICU, intensive care unit, IV, intravenous, NPO, nothing by mouth, NSAIDs, nonsteroidal anti-inflammatory drugs, NVUGIB, nonvariceal upper GI bleeding, PPI, proton pump inhibitors, PUD, peptic ulcer disease, UGI, upper GI