Skip to main content

Use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease in hospitalized older people



The aims of this study were to assess the prevalence of use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease (GERD) at hospital admission and discharge.


Patients aged 65 years or more hospitalized from 2010 to 2016 in 101 Italian internal medicine and geriatric wards in the context of the REPOSI register were scrutinized to assess if they were prescribed with drugs for peptic ulcer and GERD at hospital admission and discharge. Appropriateness of prescription was assessed considering the presence of specific conditions (i.e., history of peptic ulcer or gastrointestinal hemorrhages, advanced age, Helicobacter Pylori) or gastro-toxic drug combinations, according to the criteria provided by the reimbursement rules of the Agenzia Italiana del Farmaco (NOTA 1 and 48).


Among 4715 enrolled patients, 3899 were discharged alive. At hospital discharge, 2412 (61.9%, 95%CI: 60.3–63.4%) patients were prescribed with drugs for peptic ulcer and GERD, a 12% of increase from hospital admission. Almost half of the patients (N = 1776, 45.6%, 95%CI: 44.0–47.1%) were inappropriately prescribed or not prescribed: among the drugs for peptic ulcer and GERD users, about 60% (1444/2412) were overprescribed, and among nonusers, 22% (332/1487) were underprescribed. Among patients newly prescribed at hospital discharge, 60% (392/668) were inappropriately prescribed. The appropriateness of drugs for peptic ulcer and GERD therapy decreased by 3% from hospital admission to discharge.


Hospitalization missed the opportunity to improve the quality of prescription of this class of drug.

This is a preview of subscription content, access via your institution.


  1. Der G (2003) An overview of proton pump inhibitors. Gastroenterol Nurs 26(5):182–190

    Article  Google Scholar 

  2. Lanas A (2016) We are using too many PPIs, and we need to stop: a European perspective. Am J Gastroenterol 111(8):1085–1086.

    Article  PubMed  Google Scholar 

  3. Accessed January , 2019

  4. Reimer C (2013) Safety of long-term PPI therapy. Best Pract Res Clin Gastroenterol 27(3):443–454

    Article  CAS  Google Scholar 

  5. Haastrup PF, Thompson W, Søndergaard J, Jarbøl DE (2018) Side effects of long-term proton pump inhibitor use: a review. Basic Clin Pharmacol Toxicol 123(2):114–121. Review

    Article  CAS  PubMed  Google Scholar 

  6. Forgacs I, Loganayagam A (2008) Overprescribing proton pump inhibitors. BMJ. 336(7634):2–3

    Article  Google Scholar 

  7. Franchi C, Ardoino I, Nobili A, Pasina L, Mannucci PM, Marengoni A, Perticone F, REPOSI investigators (2017) Pattern of in-hospital changes in drug use in the older people from 2010 to 2016. Pharmacoepidemiol Drug Saf 26(12):1534–1539

    Article  CAS  Google Scholar 

  8. Franchi C, Marcucci M, Mannucci PM, Tettamanti M, Pasina L, Fortino I, Bortolotti A, Merlino L, Nobili A (2016) Changes in clinical outcomes for community-dwelling older people exposed to incident chronic polypharmacy: a comparison between 2001 and 2009. Pharmacoepidemiol Drug Saf 25(2):204–211

    Article  Google Scholar 

  9. Franchi C, Antoniazzi S, Proietti M, Nobili A, Mannucci PM, SIM-AF collaborators (2018) Appropriateness of oral anticoagulant therapy prescription and its associated factors in hospitalized older people with atrial fibrillation. Br J Clin Pharmacol 84(9):2010–2019.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ardoino I, Rossio R, Di Blanca D, Nobili A, Pasina L, Mannucci PM, Peyvandi F (2017) Franchi C; REPOSI investigators. Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people. Br J Clin Pharmacol 83(11):2528–2540

    Article  Google Scholar 

  11. Marcucci M, Franchi C, Nobili A, Mannucci PM (2017) Ardoino I; REPOSI investigators. Defining aging phenotypes and related outcomes: clues to recognize frailty in hospitalized older patients. J Gerontol A Biol Sci Med Sci 72(3):395–402

    PubMed  Google Scholar 

  12. Miller MD, Towers A (1991) Manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). University of Pittsburgh, Pittsburg

    Google Scholar 

  13. Accessed January, 2019

  14. Yadlapati R, Kahrilas PJ (2017) When is proton pump inhibitor use appropriate? BMC Med 15(1):36.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sverdén E, Agréus L, Dunn JM, Lagergren J (2019) Peptic ulcer disease. BMJ. 367:l5495.

    Article  PubMed  Google Scholar 

  16. 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

    Article  CAS  Google Scholar 

  17. Pasina L, Nobili A, Tettamanti M, Salerno F, Corrao S, Marengoni A, Iorio A, Marcucci M, Mannucci PM, REPOSI investigators (2011) Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly. Eur J Intern Med 22(2):205–210

    Article  CAS  Google Scholar 

  18. Sun J, Sun H, Cui M, Sun Z, Li W, Wei J, Zhou S (2018) The use of anti-ulcer agents and the risk of chronic kidney disease: a meta-analysis. Int Urol Nephrol 50(10):1835–1843. Review

    Article  PubMed  Google Scholar 

  19. Hussain S, Siddiqui AN, Habib A, Hussain MS, Najmi AK (2018) Proton pump inhibitors' use and risk of hip fracture: a systematic review and meta-analysis. Rheumatol Int 38(11):1999–2014. Review

    Article  PubMed  Google Scholar 

  20. Scarpignato C, Gatta L, Zullo A, Blandizzi C, SIF-AIGO-FIMMG Group; Italian Society of Pharmacology, the Italian Association of Hospital Gastroenterologists, and the Italian Federation of General Practitioners (2016) Effective and safe proton pump inhibitor therapy in acid-related diseases - a position paper addressing benefits and potential harms of acid suppression. BMC Med 14(1):179 Review

    Article  Google Scholar 

  21. Xie Y, Bowe B, Li T, Xian H, Yan Y, Al-Aly Z (2017) Risk of death among users of proton pump inhibitors: a longitudinal observational cohort study of United States veterans. BMJ Open 7(6):e015735.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Franchi C, Ardoino I, Rossio R, Nobili A, Biganzoli EM, Marengoni A, Marcucci M, Pasina L, Tettamanti M, Corrao S, Mannucci PM, REPOSI investigators (2016) Prevalence and risk factors associated with use of QT-prolonging drugs in hospitalized older people. Drugs Aging 33(1):53–61.

    Article  CAS  PubMed  Google Scholar 

  23. Franchi C, Tettamanti M, Djade CD, Pasina L, Mannucci PM, Onder G, Gussoni G, Manfellotto D, Bonassi S, Salerno F, Nobili A, ELICADHE investigators (2016) E-learning in order to improve drug prescription for hospitalized older patients: a cluster-randomized controlled study. Br J Clin Pharmacol 82(1):53–63

    Article  Google Scholar 

  24. Franchi C, Antoniazzi S, Ardoino I, Proietti M, Marcucci M, Santalucia P, Monzani V, Mannucci PM, Nobili A, SIM-AF collaborators (2019) Simulation-based education for physicians to increase oral anticoagulants in hospitalized elderly patients with atrial fibrillation. Am J Med 132(8):e634–e647.

    Article  PubMed  Google Scholar 

  25. Antoniazzi S, Ardoino I, Proietti M, Monzani V, Mannucci PM, Nobili A, Franchi C, SIM-AF collaborators (2019) Appropriateness of prescription of oral anticoagulant therapy in acutely hospitalized older people with atrial fibrillation. Secondary analysis of the SIM-AF cluster randomized clinical trial. Br J Clin Pharmacol 85(9):2134–2142.

    Article  CAS  PubMed  Google Scholar 

  26. Davis KW, Hanners RE, Lockwood SM (2017) Implementation of a proton pump inhibitor stewardship program. Am J Health Syst Pharm 74(12):932–937.

    Article  PubMed  Google Scholar 

  27. Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid FJ, Rojas-Fernandez C, Walsh K, Welch V, Moayyedi P (2017) Deprescribing proton pump inhibitors: evidence-based clinical practice guideline. Can Fam Physician 63(5):354–364

    PubMed  PubMed Central  Google Scholar 

  28. Walsh K, Kwan D, Marr P, Papoushek C, Lyon WK (2016) Deprescribing in a family health team: a study of chronic proton pump inhibitor use. J Prim Health Care 8(2):164–171.

    Article  PubMed  Google Scholar 

Download references


We acknowledge all the investigators and co-authors of the REPOSI (REgistro POliterapie SIMI, Società Italiana di Medicina Interna) Study Group, listed in the Supplementary Appendix 1.

Author information

Authors and Affiliations



C.F. wrote the manuscript; C.F and I.A. designed the study research; C.F. and I.A. performed the research; I.A. analyzed the data; P.M.M. and A.N. critically revised the manuscript.

Corresponding author

Correspondence to C Franchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material


(DOCX 105 kb)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Franchi, C., Mannucci, P., Nobili, A. et al. Use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease in hospitalized older people. Eur J Clin Pharmacol 76, 459–465 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: