AGA: Best Practices for Prescribing PPIs

The American Gastroenterological Association (AGA) has released a Clinical Practice Update which offers best practice recommendations for appropriate use of proton pump inhibitors (PPIs). The update was published in the journal Gastroenterology.

Between 1999 and 2012, the number of patients on long-term PPI therapy doubled, as did the number of adverse events associated with use of these medications. While the benefits of treatment should be weighed against the risks on an individual basis, the AGA has provided recommendations to help clinicians make treatment decisions with regards to PPI use. The recommendations are based on expert opinion and relevant literature (through July 2016), however the AGA states that currently there is insufficient evidence to recommend specific strategies to reduce the potential adverse events associated with PPIs.

The AGA Best Practice Advice includes the following:

• For gastroesophageal reflux disease (GERD) and acid-related complications: use PPI for short-term healing, maintenance of healing, and long-term symptom control
• Uncomplicated GERD that responds to short-term PPI: an attempt should be made to stop or reduce treatment. If reduction is not possible, consider ambulatory esophageal pH/impedance monitoring to help distinguish GERD from function syndrome before long-term use is considered.
• Barrett’s esophagus, symptomatic GERD: long-term PPI should be recommended
• Asymptomatic Barrett’s esophagus: consider long-term PPI
• Risk of ulcer-related bleeding from NSAIDs: if NSAIDs are continued, PPI should be recommended
• Periodically reevaluate PPI dose, use lowest effective dose to manage condition
• Long-term PPI users: do not routinely use probiotics to prevent infection 
• Long-term PPI users: do not raise calcium, vitamin B12, or magnesium intake beyond recommended dietary allowance
• Routine screening of bone mineral density, serum creatinine, magnesium, or vitamin B12 in long-term PPI users unnecessary
• Certain PPI formulations should not be prescribed based on possible risks 

In addition to these recommendations, the AGA has developed talking points for clinicians to use to help facilitate discussions with patients about the importance of using PPIs as directed. 

For more information visit Gastro.org.