PMID- 32091419 OWN - NLM STAT- MEDLINE DCOM- 20200701 LR - 20240328 IS - 1572-0241 (Electronic) IS - 0002-9270 (Print) IS - 0002-9270 (Linking) VI - 115 IP - 5 DP - 2020 May TI - Physicians' Perceptions of Proton Pump Inhibitor Risks and Recommendations to Discontinue: A National Survey. PG - 689-696 LID - 10.14309/ajg.0000000000000558 [doi] AB - OBJECTIVE: To provide contemporary estimates of internists' perceptions of adverse effects associated with proton pump inhibitors (PPIs) and self-reported clinical use. METHODS: We invited 799 internists, including specialists and postgraduate trainees, to complete an online survey. Topics included perceptions of PPI adverse effects (AEs) and effectiveness for upper gastrointestinal bleeding (UGIB) prevention, changes in prescribing, and management recommendations for patients using PPIs for gastroesophageal reflux disease or UGIB prevention. We used logistic regression to identify factors associated with appropriate PPI continuation in the scenario of a patient at high risk for UGIB. RESULTS: Among 437 respondents (55% response rate), 10% were trainees and 72% specialized in general medicine, 70% were somewhat/very concerned about PPI AEs, and 76% had somewhat/very much changed their prescribing. A majority believed PPIs increase the risk for 6 of 12 AEs queried. Fifty-two percent perceived PPIs to be somewhat/very effective for UGIB prevention. In a gastroesophageal reflux disease scenario in which PPI can be safely discontinued, 86% appropriately recommended PPI discontinuation. However, in a high-risk UGIB prevention scenario in which long-term PPI use is recommended, 79% inappropriately recommended discontinuation. In this latter scenario, perceived effectiveness for bleeding prevention was strongly associated with continuing PPI (odds ratio 7.68, P < 0.001 for moderately; odds ratio 17.3, P < 0.001 for very effective). Other covariates, including concern about PPI AEs, had no significant association. DISCUSSION: Most internists believe PPIs cause multiple AEs and recommend discontinuation even in patients at high risk for UGIB. Future interventions should focus on ensuring that PPIs are prescribed appropriately according to individual risks and benefits. FAU - Kurlander, Jacob E AU - Kurlander JE AD - Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. AD - Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA. FAU - Rubenstein, Joel H AU - Rubenstein JH AD - Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. AD - Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA. AD - Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA. FAU - Richardson, Caroline R AU - Richardson CR AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA. AD - Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA. FAU - Krein, Sarah L AU - Krein SL AD - Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. AD - Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA. AD - Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA. FAU - De Vries, Raymond AU - De Vries R AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA. AD - Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA. AD - Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA. FAU - Zikmund-Fisher, Brian J AU - Zikmund-Fisher BJ AD - Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. AD - Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA. AD - Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA. FAU - Yang, Yu-Xiao AU - Yang YX AD - Department of Medicine, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. AD - The Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA. FAU - Laine, Loren AU - Laine L AD - Yale School of Medicine, New Haven, Connecticut, USA. AD - Veterans Affair Connecticut Healthcare System, West Haven, Connecticut, USA. FAU - Weissman, Arlene AU - Weissman A AD - Research Center, American College of Physicians, Philadelphia, Pennsylvania, USA. FAU - Saini, Sameer D AU - Saini SD AD - Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. AD - Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA. AD - Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA. LA - eng GR - I01 HX002693/HX/HSRD VA/United States GR - K23 DK118179/DK/NIDDK NIH HHS/United States GR - UL1 TR001863/TR/NCATS NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - Am J Gastroenterol JT - The American journal of gastroenterology JID - 0421030 RN - 0 (Proton Pump Inhibitors) SB - IM CIN - Am J Gastroenterol. 2020 May;115(5):681-682. PMID: 32058342 MH - Female MH - Gastroesophageal Reflux/complications/*drug therapy MH - Gastrointestinal Hemorrhage/etiology/*prevention & control MH - Humans MH - Male MH - Middle Aged MH - *Perception MH - Physicians/*psychology MH - *Practice Patterns, Physicians' MH - Proton Pump Inhibitors/*therapeutic use MH - *Self Report MH - Surveys and Questionnaires PMC - PMC7196016 MID - NIHMS1551796 EDAT- 2020/02/25 06:00 MHDA- 2020/07/02 06:00 PMCR- 2021/05/01 CRDT- 2020/02/25 06:00 PHST- 2020/02/25 06:00 [pubmed] PHST- 2020/07/02 06:00 [medline] PHST- 2020/02/25 06:00 [entrez] PHST- 2021/05/01 00:00 [pmc-release] AID - 00000434-202005000-00016 [pii] AID - 10.14309/ajg.0000000000000558 [doi] PST - ppublish SO - Am J Gastroenterol. 2020 May;115(5):689-696. doi: 10.14309/ajg.0000000000000558.