European Journal of Clinical Pharmacology

, Volume 75, Issue 9, pp 1327–1329 | Cite as

Proton pump inhibitors: why this gap between guidelines and prescribing practices in geriatrics?

  • Hugues MichelonEmail author
  • A. Delahaye
  • L. Fellous
  • B. Davido
  • A. Dinh
  • J. L. Le Quintrec
  • L. Teillet
  • M. Herr
Letter to the Editor

The widespread use of proton pump inhibitors (PPI) has raised concerns about their potential adverse effects and impact on healthcare costs (about £100 million in England and £2 billion worldwide spent unnecessarily on PPI each year) [1, 2]. Potential adverse effects of PPI include community-acquired pneumonia, Clostridium difficile infections, osteoporosis and bone fractures, chronic kidney disease, vitamin B12 deficiency, cancers, and malignant diseases if used long term [3, 4]. Observational studies have reported the frequent overuse of PPI, especially in geriatrics [1, 5, 6, 7, 8]. The latest updates of the Beers and STOPP/START lists for potentially inappropriate prescriptions include the use of PPI beyond 8 weeks without justification [9, 10]. To provide a better understanding of the inappropriate use of PPI in older people, we examined the real-life use of PPI in elderly hospitalized French patients.

We conducted a survey in six voluntary medicine wards (five geriatric medicine...



The authors would like to thank Ms. Sarah Fontenay, Ms. Nolween Clément-Rio, Ms. Isaure Magnus, and Mr. Hugues Nanguem for their support in data collection.


  1. 1.
    Moriarty F, Bennett K, Cahir C, Fahey T (2016) Characterizing potentially inappropriate prescribing of proton pump inhibitors in older people in primary care in Ireland from 1997 to 2012. J Am Geriatr Soc 64(12):e291–e296. CrossRefGoogle Scholar
  2. 2.
    Forgacs I, Loganayagam A (2008) Overprescribing proton pump inhibitors. Bmj 336(7634):2–3. CrossRefGoogle Scholar
  3. 3.
    Maes ML, Fixen DR, Linnebur SA (2017) Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence. Ther Adv Drug Saf 8(9):273–297. CrossRefGoogle Scholar
  4. 4.
    Halfdanarson OO, Fall K, Ogmundsdottir MH, Lund SH, Steingrimsson E, Ogmundsdottir HM, Zoega H (2018) Proton pump inhibitor use and risk of breast cancer, prostate cancer, and malignant melanoma: an Icelandic population-based case-control study. Pharmacoepidemiol Drug Saf 28:471–478. CrossRefGoogle Scholar
  5. 5.
    Agence Nationale de Sécurité du Médicament (2018) Utilisation des inhibiteurs de la pompe à protons (IPP) - Étude observationnelle à partir des donnéesdu SNDS, Saint-Denis, France, 2015Google Scholar
  6. 6.
    Rane PP, Guha S, Chatterjee S, Aparasu RR (2017) Prevalence and predictors of non-evidence based proton pump inhibitor use among elderly nursing home residents in the US. Res Soc Adm Pharm 13(2):358–363. CrossRefGoogle Scholar
  7. 7.
    Voukelatou P, Vrettos I, Emmanouilidou G, Dodos K, Skotsimara G, Kontogeorgou D, Kalliakmanis A (2019) Predictors of inappropriate proton pump inhibitors use in elderly patients. Curr Gerontol Geriatr Res 2019:7591045. CrossRefGoogle Scholar
  8. 8.
    Schepisi R, Fusco S, Sganga F, Falcone B, Vetrano DL, Abbatecola A, Corica F, Maggio M, Ruggiero C, Fabbietti P, Corsonello A, Onder G, Lattanzio F (2016) Inappropriate use of proton pump inhibitors in elderly patients discharged from acute care hospitals. J Nutr Health Aging 20(6):665–670. CrossRefGoogle Scholar
  9. 9.
    O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P (2015) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44(2):213–218. CrossRefGoogle Scholar
  10. 10.
    By the American Geriatrics Society Beers Criteria Update Expert P (2015) American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 63(11):2227–2246. CrossRefGoogle Scholar
  11. 11.
    Haute Autorité de Santé (2009) Les inhibiteurs de la pompe à protons chez l’adulte - Bon usage des médicaments – Juin 2009- Mises à jour décembre2009Google Scholar
  12. 12.
    Mat Saad AZ, Collins N, Lobo MM, O’Connor HJ (2005) Proton pump inhibitors: a survey of prescribing in an Irish general hospital. Int J Clin Pract 59(1):31–34. CrossRefGoogle Scholar
  13. 13.
    Travis AC, Pievsky D, Saltzman JR (2012) Endoscopy in the elderly. Am J Gastroenterol 107(10):1495–1501; quiz 1494, 1502. CrossRefGoogle Scholar
  14. 14.
    Ray WA, Chung CP, Murray KT, Smalley WE, Daugherty JR, Dupont WD, Stein CM (2018) Association of oral anticoagulants and proton pump inhibitor cotherapy with hospitalization for upper gastrointestinal tract bleeding. JAMA 320(21):2221–2230. CrossRefGoogle Scholar
  15. 15.
    Li L, Geraghty OC, Mehta Z, Rothwell PM, Oxford Vascular S (2017) Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study. Lancet 390(10093):490–499. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hugues Michelon
    • 1
    Email author
  • A. Delahaye
    • 2
  • L. Fellous
    • 1
  • B. Davido
    • 3
  • A. Dinh
    • 3
  • J. L. Le Quintrec
    • 2
  • L. Teillet
    • 2
  • M. Herr
    • 4
    • 5
  1. 1.Service de Pharmacie, Hôpitaux Universitaires Paris Ile-de-France Ouestsites Sainte-Périne et Raymond Poincaré, AP-HPParisFrance
  2. 2.Service de Gériatrie, Hôpitaux Universitaires Paris Ile-de-France Ouestsites Sainte-Périne et Ambroise Paré, AP-HPParisFrance
  3. 3.Service de Médecine Aigue Spécialisée et Maladies Infectieuses, Hôpitaux Universitaires Paris Ile-de-France Ouestsite Raymond Poincaré, AP-HPGarchesFrance
  4. 4.INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, FranceUniversité de Versailles St-Quentin-en-YvelinesMontigny le BretonneuxFrance
  5. 5.Département Hospitalier d’Epidémiologie et de Santé Publique, Hôpitaux Universitaires Paris Ile-de-France Ouestsite Sainte Périne, AP-HPParisFrance

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