Journal of Liver

Injudicious use of proton pump inhibitors: An audit from a tertiary care center in UAE

3^rd World Liver Congress

December 17-18, 2018 Abu Dhabi, UAE

Fatima Hazin and M A Zahid

Tawam Hospital, UAE

Posters & Accepted Abstracts: J Liver

Abstract:

Background & Aim: Proton Pump Inhibitors (PPIs) are widely used and their use is associated with increased risk of adverse events including increased risk of death. However, they are still widely prescribed often injudiciously in clinical practice. We aimed to examine the current practices of PPI prescription especially the awareness among clinicians of its potential hazards.

Design: It is a retrospective audit study at Tawam Hospital, Al Ain, UAE.

Method: A random cohort of 50 inpatients currently on PPI therapy was selected. Information related to PPI therapy was gathered using patient management software CERNER. Important information included indications and duration of therapy, potential drug interactions and drug review or treatment modification along with useful information related to patient characteristics like demographics and comorbidities.

Results: A total of 50 patients on current PPI therapy were selected for analysis. Average age was 68.34 years (Range 17-100). Common comorbidities included Type-2 Diabetes mellitus (44%), Hypertension (68%), chronic kidney disease (34%) and Ischemic heart disease (20%). Common drug interactions included Clopidogrel (24%), Benzodiazepine (4.4%), Phenytoin (4.4%), Apixiban (6%) and Warfarin (8%). Average duration of PPI therapy was 72.1 months (range 2-115). The indications were GERD (5/50, 10%), Prophylaxis on anti-platelet therapy (11/50 22%) and gastritis (1/50, 2%) whilst there was no clear indication in 23 patients (46%). PPIs were also considered as prophylaxis for drugs that do not require PPI cover including warfarin (6/50, 12%), steroids (3/50, 6%) and Apixiban (2/50, 4%). The average dose of therapy was 33.8 mg daily with treatment divided among various drugs Omeprazole (8/50, 16%), Pantoprazole (16/50, 32%), Esomeprazole (24/50, 48%). PPI therapy was started as intravenous treatment in 1 patient without any discernible indication. Drug therapy was reviewed in most of the patients in prior 6 months but only resulted in drug cessation in 11(22%) patients with no treatment de-escalation in any patients.

Conclusion: The results suggest a trend towards excessive and often injudicious use of PPIs in most of the patients. Limiting PPI use and duration to instances where it is medically indicated is highly warranted especially considering the increasing concerns regarding their long term safety.

Biography :

Fatima Hazin is a Medical Resident in Tawam Hospital, Al-Ain. She is currently pursuing her third year Residency in Internal Medicine.

E-mail: fhazin@seha.ae