Veterans diagnosed with reflux issues often start on high doses of PPIs, rarely stop therapy

US veterans diagnosed with gastroesophageal reflux disease (GERD) are frequently prescribed doses of proton pump inhibitors (PPIs) that are much higher than recommended, according to a new study, published in the February 16, 2013 issue of Journal of General Internal Medicine.

After evaluating more than 1,600 veterans at the Hines, Ill., Veterans Administration facility from 2003 to 2009, Study lead author Andrew Gawron, MD, a fellow in the division of gastroenterology and the Center for Healthcare Studies at Northwestern University Feinberg School of Medicine, and colleagues found that the majority of patients received more than a 3-month initial supply of PPIs such as omeprazole (Prilosec). In addition, 23.3% of patients were given a high initial total daily dose of prescriptions and very few patients who started on high dose therapy had reductions in dosing more than 2 years after their initial prescription. Only 7.1 % of patients with initial high daily dose PPI prescriptions had evidence of step-down therapy.

“It seems that once these veterans are prescribed a PPI, they are rarely taken off of it. Proton pump inhibitors are provided ubiquitously in medicine and, although they provide relief for many patients, optimal prescribing is important to avoid prolonged, unnecessary use, and cost,” Dr Gawron said.

The researchers recommended that PPIs be prescribed at the lowest effective dose for 4 to 8 weeks. If symptoms persist after 8 weeks, efforts should be made to evaluate other potential causes of symptoms and alternative approaches to therapy. “This approach is a top priority in the ‘Choosing Wisely’ campaign initiated last year by the American Board of Internal Medicine and the American Gastroenterology Association,” according to a statement from Northwestern University.