Provider Awareness of Practice Guidelines Is Key to Appropriate Use of PPIs

January 28, 2021

Proton pump inhibitors (PPIs) are proven medications of choice for gastroesophageal reflux disease (GERD) and other disorders. However, the significant increase in use of PPIs for ill-defined indications over the years has been associated with adverse outcomes and increased health care costs. A study in the January issue of JAMDA suggests that provider awareness of best practice guidelines on PPI use, along with a focus on patient education, may help promote safe and effective use of this treatment.

In The Use and Misuse of Proton Pump Inhibitors: An Opportunity for Deprescribing, the author, T.S. Dharmarajan, MD, MACP, FRCP(E), AGSF, stressed that PPIs are valuable, irreplaceable drugs in the prevention and treatment of certain disorders for specific durations of time. However, he cited evidence suggesting that excessive and inappropriately prolonged PPI use is associated with various adverse effects. These include allergic reactions, acute interstitial nephritis, chronic kidney disease, poor cardiovascular outcomes, dementia, and drug interactions. Additionally, there are potential complications due to gastric acid inhibition, such as gastrointestinal infections, pneumonia, nutrient deficiencies, fractures, spontaneous bacterial peritonitis, and small intestinal bacterial overgrowth.

Dr. Dharmarajan concluded that education of providers and patients, stewardship, and motivation are key to appropriate use of PPIs for the right indications. He added that efforts at deprescribing a PPI “may be attempted following discussion with the patients.” Deprescribing approaches include stopping the drug, reducing the dose, or using “on-demand” therapy after completing the course of treatment for the specific indication. Follow-up is recommended, he observed, for “recurrence of manifestations.” In the event of recurrence, he said, the PPI may need to be reinstituted.

This study was conducted by researchers at the Montefiore Medical Center, Wakefield Campus, Bronx, NY.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.


About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.