Inappropriate Long-Term Proton Pump Inhibitor Use in a General Medicine Outpatient Department: A Cross-Sectional Study

Abstract

 Introduction: Proton pump inhibitors (PPIs) are among the most commonly prescribed medications worldwide, yet inappropriate long-term PPI use is increasingly recognized as a global clinical problem.

 Objectives: To determine the prevalence and patterns of inappropriate long-term PPI use, assess documentation quality, identify associated factors, and evaluate patient awareness in a general medicine outpatient department.

Methods: A cross-sectional observational study of 120 adult patients receiving long-term PPI therapy (≥8 weeks) was conducted at a tertiary care hospital in India. PPI use was classified as appropriate or inappropriate using evidence-based guideline criteria by two independent reviewers.

Results: Of 120 patients, 70 (58.3%; 95% CI, 49.1%–67.0%) had inappropriate long-term PPI use. Common inappropriate indications were nonspecific dyspepsia without diagnostic confirmation (35.7%), undocumented indication (28.6%), and prophylaxis without risk factors (21.4%). Documentation quality was poor; only 32.5% had a recorded indication. Factors independently associated with inappropriate use included prescription by general physicians (OR, 3.8), polypharmacy (OR, 2.9), therapy duration >1 year (OR, 4.2), and self-prescription (OR, 5.6). Potential adverse effects were identified in 35% of patients.

Conclusions: Inappropriate long-term PPI use affects more than half of patients in general medicine outpatient settings. Systematic interventions including prescriber education, electronic decision support, and structured deprescribing protocols are urgently needed.