Overutilization of proton pump inhibitors: a review of cost-effectiveness and risk [corrected]

Am J Gastroenterol. 2009 Mar:104 Suppl 2:S27-32. doi: 10.1038/ajg.2009.49.


Proton pump inhibitors (PPIs) are superior to histamine-2 receptor antagonists for the treatment of gastroesophageal reflux disease (GERD) and erosive esophagitis. Antisecretory therapy (AST), however, accounts for significant cost expenditure in the United States including over-the-counter and prescription formulations. Moreover, emerging data illustrate the potential risks associated with long-term PPI therapy including variations in bioavailability of common medications, vitamin B12 deficiency, Clostridium difficile-associated diarrhea, community-acquired pneumonia, and hip fracture. For these reasons, it is imperative to use the lowest dose of drug necessary to achieve desired therapeutic goals. This may entail the use of step-down, step-off, or on-demand PPI therapy for the treatment of GERD. In addition, PPIs are the most commonly used medications for stress ulcer prophylaxis (SUP), despite little evidence to support their use. Compounding this problem is evidence that patients erroneously administered SUP are often discharged on long-term PPI therapy. Pharmacy-driven step-down orders, limitation of the use of PPIs for SUP in non-ICU settings, and meticulous chart review to ensure that hospitalized patients are not discharged home on a PPI without an appropriate indication are interventions that can ensure proper PPI utilization with minimal of risk and optimization of cost-effectiveness.

Publication types

  • Review

MeSH terms

  • Cost-Benefit Analysis
  • Drug Costs
  • Drug Utilization
  • Esophagitis / drug therapy*
  • Gastroesophageal Reflux / drug therapy*
  • Health Expenditures
  • Histamine H2 Antagonists / adverse effects
  • Histamine H2 Antagonists / economics
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Peptic Ulcer / etiology
  • Peptic Ulcer / prevention & control
  • Proton Pump Inhibitors / adverse effects
  • Proton Pump Inhibitors / economics
  • Proton Pump Inhibitors / therapeutic use*
  • Stress, Physiological


  • Histamine H2 Antagonists
  • Proton Pump Inhibitors