scholarly journals Proton pump inhibitor use in a university teaching hospital

2012 ◽  
Author(s):  
Maria Meli ◽  
Renato Malta ◽  
Luigi Aprea ◽  
Andrea Pasquale ◽  
Concetta La Seta ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Proton Pump Inhibitor ◽  
Adverse Events ◽  
Obesity Surgery ◽  
Proton Pump ◽  
General Surgery ◽  
University Teaching ◽  
Total Cost ◽  
Bed Days

Introduction Proton pump inhibitors (PPIs) are highly prescribed drugs in Italy and in particular in the Sicilian region but little is known about their use in the hospital setting.Materials and methods PPI utilization and related costs were reviewed retrospectively by examining the pharmaceutical records of drug dispensation to the various wards of the Policlinico Universitario P. Giaccone of Palermo in 2010. Differences in the prescribing rates and drug preferences among the different clinical wards were analyzed.Results A total of 20,420 patients were hospitalized at the Policlinico of Palermo in 2010. Overall, the consumption of PPIs was 120 DDD/100 bed-days for the year 2010 with a total cost of 42,780 euros. Omeprazole and esomeprazole were the most commonly prescribed molecules accounting for over 70% of all prescriptions: nevertheless, wide differences in drug choices were noted even within the same ward. As expected, greater utilization rates were registered in the Internal Medicine and General Surgery departments. In particular, the highest consumption was observed in the Oncology, Geriatry and Obesity Surgery wards, with about 250 DDD/100 bed-days. All wards reported intravenous PPI administration suggesting some inappropriate use.Discussion From our data, PPIs appear to be moderately over-used at the Policlinico of Palermo. This practice may lead to the inappropriate continuation of therapy in primary care, further increasing costs and risks of adverse events. A survey evaluating in more detail the appropriateness of prescriptions is advisable.

scholarly journals Evidence-Based Recommendations for Short- and Long-Term Management of Uninvestigated Dyspepsia in Primary Care: An Update of the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool

2005 ◽  
Vol 19 (5) ◽  
pp. 285-303 ◽  
Author(s):  
Sander JO Veldhuyzen van Zanten ◽  
Marc Bradette ◽  
Naoki Chiba ◽  
David Armstrong ◽  
Alan Barkun ◽  
...  
Keyword(s):  
Primary Care ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Clinical Management ◽  
Management Tool ◽  
Noninvasive Testing ◽  
Ulcer Bleeding ◽  
High Dose ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

The present paper is an update to and extension of the previous systematic review on the primary care management of patients with uninvestigated dyspepsia (UD). The original publication of the clinical management tool focused on the initial four- to eight-week assessment of UD. This update is based on new data from systematic reviews and clinical trials relevant to UD. There is now direct clinical evidence supporting a test-and-treat approach in patients with nondominant heartburn dyspepsia symptoms, and head-to-head comparisons show that use of a proton pump inhibitor is superior to the use of H2-receptor antagonists (H2RAs) in the initial treatment of Helicobacter pylori-negative dyspepsia patients. Cisapride is no longer available as a treatment option and evidence for other prokinetic agents is lacking. In patients with long-standing heartburn-dominant (ie, gastroesophageal reflux disease) and nonheartburn-dominant dyspepsia, a once-in-a-lifetime endoscopy is recommended. Endoscopy should also be considered in patients with new-onset dyspepsia that develops after the age of 50 years. Conventional nonsteroidal anti-inflammatory drugs, acetylsalicylic acid and cyclooxygenase-2-selective inhibitors can all cause dyspepsia. If their use cannot be discontinued, cotherapy with either a proton pump inhibitor, misoprostol or high-dose H2RAs is recommended, although the evidence is based on ulcer data and not dyspepsia data. In patients with nonheartburn-dominant dyspepsia, noninvasive testing for H pylori should be performed and treatment given if positive. When starting nonsteroidal anti-inflammatory drugs for a prolonged course, testing and treatment with H2RAs are advised if patients have a history of previous ulcers or ulcer bleeding.

scholarly journals Efficacy of Magnetic Sphincter Augmentation versus Nissen Fundoplication for Gastroesophageal Reflux Disease in Short Term: A Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Ming-yu Chen ◽  
Di-yu Huang ◽  
Angela Wu ◽  
Yi-bin Zhu ◽  
He-pan Zhu ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Proton Pump Inhibitor ◽  
Gastroesophageal Reflux ◽  
Adverse Events ◽  
Proton Pump ◽  
Reflux Disease ◽  
Operative Time ◽  
Meta Analysis ◽  
Magnetic Sphincter Augmentation ◽  
Short Term

Background. The efficacy of Magnetic Sphincter Augmentation (MSA) and its outcomes for Gastroesophageal Reflux Disease (GERD) are uncertain. Therefore, we aimed to summarize and analyze the efficacy of two treatments for GERD.Methods. The meta-analysis search was performed, using four databases. All studies from 2005 to 2016 were included. Pooled effect was calculated using either the fixed or random effects model.Results. A total of 4 trials included 624 patients and aimed to evaluate the differences in proton-pump inhibitor use, complications, and adverse events. MSA had a shorter operative time (MSA and NF: RR = −18.80, 95% CI: −24.57 to −13.04, andP=0.001) and length of stay (RR = −14.21, 95% CI: −24.18 to −4.23, andP=0.005). Similar proton-pump inhibitor use, complication (P=0.19), and severe dysphagia for dilation were shown in both groups. Although there is no difference between the MSA and NF in the number of adverse events, the incidence of postoperative gas or bloating (RR = 0.71, 95% CI: 0.54–0.94, andP=0.02) showed significantly different results. However, there is no significant difference in ability to belch and ability to vomit.Conclusions. MSA can be recommended as an alternative treatment for GERD according to their short-term studies, especially in main-features of gas-bloating, due to shorter operative time and less complication of gas or bloating.

scholarly journals S1439 Oh My GERD: Reducing Proton Pump Inhibitor Overuse in an Internal Medicine Residency Clinic

2021 ◽  
Vol 116 (1) ◽  
pp. S661-S661
Author(s):  
Helen Liu ◽  
James Fleming ◽  
Mahalya Gogerly-Moragoda ◽  
Catherine Swarts ◽  
Claire Ufongene ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Internal Medicine Residency
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