Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May 30;11:1756284818777943.
doi: 10.1177/1756284818777943. eCollection 2018.

Proton-pump Inhibitors Among Adults: A Nationwide Drug-Utilization Study

Affiliations
Free PMC article

Proton-pump Inhibitors Among Adults: A Nationwide Drug-Utilization Study

Óskar Ö Hálfdánarson et al. Therap Adv Gastroenterol. .
Free PMC article

Abstract

Background: The use of proton-pump inhibitors (PPIs) has grown worldwide, and there are concerns about increased unsubstantiated long-term use. The aim of the study was to describe the real-world use of PPIs over the past decade in an entire national population.

Methods: This was a nationwide population-based drug-utilization study. Patterns of outpatient PPI use among adults in Iceland between 2003 and 2015 were investigated, including annual incidence and prevalence, duration of use, and dose of tablet used (lower versus higher), as well as the proportion of PPI use attributable to gastroprotection.

Results: We observed 1,372,790 prescription fills over the entire study period, of which 95% were for higher-dose PPIs. Annual incidence remained stable across time (3.3-4.1 per 100 persons per year), while the annual prevalence increased from 8.5 per 100 persons to 15.5 per 100 persons. Prevalence increased with patient age and was higher among women than men. Duration of treatment increased with patients' age (36% of users over 80 years remained on treatment after 1 year compared with 13% of users aged 19-39 years), and was longer among those initiating on a higher dose compared with a lower dose. The proportion of PPI users concurrently using nonsteroidal anti-inflammatory drugs decreased over the study period, while the proportion concurrently using acetylsalicylic acid, oral anticoagulants, or platelet inhibitors increased.

Conclusions: In this nationwide study, a considerable increase in overall outpatient use of PPIs over a 13-year period was observed, particularly among older adults. Patients were increasingly treated for longer durations than recommended by clinical guidelines and mainly with higher doses.

Keywords: incidence; nationwide; pharmacoepidemiology; prevalence; proton-pump inhibitors; treatment duration.

Conflict of interest statement

Conflict of interest statement: The authors declare no conflicts of interest in preparing this article.

Figures

Figure 1.
Figure 1.
Proton-pump inhibitor (PPI) use among adults in Iceland during 2003–2015, measured in million dispensed defined daily doses (DDDs). (a) Overall use by PPI type; (b–d) overall use by specialty of prescribing physician and PPI type.
Figure 2.
Figure 2.
Annual prevalence and incidence (per 100 persons) of proton-pump inhibitor use among adults in Iceland.
Figure 3.
Figure 3.
Age- and sex-specific prevalence of proton-pump inhibitor use among adults in Iceland in 2015.
Figure 4.
Figure 4.
Duration of PPI treatment among incident users: (a) by age; (b) by initial dose strength of the proton-pump inhibitors (PPIs), measured as the proportion of patients covered.
Figure 5.
Figure 5.
Concurrent use of proton-pump inhibitors with drugs that are ulcerogenic or increase the risk of upper gastrointestinal bleeding. NSAIDs, nonsteroidal anti-inflammatory drugs.

Similar articles

See all similar articles

Cited by 10 articles

See all "Cited by" articles

References

    1. Raghunath AS, Hungin AP, Mason J, et al. Symptoms in patients on long-term proton pump inhibitors: prevalence and predictors. Aliment Pharmacol Ther 2009; 29: 431–439. - PubMed
    1. Dent J, El-Serag HB, Wallander MA, et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005; 54: 710–717. - PMC - PubMed
    1. Lundell L, Miettinen P, Myrvold HE, et al. Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis. Clin Gastroenterol Hepatol 2009; 7: 1292–1298. - PubMed
    1. Mahon D, Rhodes M, Decadt B, et al. Randomized clinical trial of laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux. Br J Surg 2005; 92: 695–699. - PubMed
    1. Mehta S, Bennett J, Mahon D, et al. Prospective trial of laparoscopic nissen fundoplication versus proton pump inhibitor therapy for gastroesophageal reflux disease: seven-year follow-up. J Gastrointest Surg 2006; 10: 1312–1316. - PubMed

LinkOut - more resources

Feedback