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Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship

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Abstract

Proton pump inhibitors (PPIs) have been available for over three decades and are among the most commonly prescribed medications. They are effective in treating a variety of gastric acid-related disorders. They are freely available and based on current evidence, use of PPIs for inappropriate indications and duration appears to be common. Over the years, concerns have been raised on the safety of PPIs as they have been associated with several adverse effects. Hence, there is a need for PPI stewardship to promote the use of PPIs for appropriate indication and duration. With this objective, the Indian Society of Gastroenterology has formulated guidelines on the rational use of PPIs. The guidelines were developed using a modified Delphi process. This paper presents these guidelines in detail, including the statements, review of literature, level of evidence and recommendations. This would help the clinicians in optimizing the use of PPIs in their practice and promote PPI stewardship.

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Acknowledgements

We thank Ms. Nisha, Secretarial Assistant, ISG, for her help in organizing the virtual and in-person meetings.

Funding

The academic activity was supported by the Indian Society of Gastroenterology.

The face-to-face meeting in Delhi was supported by an unrestricted grant from Sun Pharmaceuticals and they had no role in any academic activity and content related to the guideline formulation.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Christian Medical College and Hospital, Vellore, 632 004, India

    Amit Kumar Dutta

  2. Gastro 1 Hospital, Ahmedabad, 380 060, India

    Abhinav Jain

  3. Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Vaneet Jearth, Vishal Sharma & Usha Dutta

  4. Dayanand Medical College and Hospital, Ludhiana, 141 001, India

    Ramit Mahajan

  5. All India Institute of Medical Sciences, Bhubaneswar, 751 019, India

    Manas Kumar Panigrahi

  6. Apollo Hospital, Kolkata, 700 054, India

    Mahesh Kumar Goenka

  7. Paras Hospitals, Panchkula, 134 109, India

    Rakesh Kochhar

  8. All India Institute of Medical Sciences, New Delhi, 110 029, India

    Govind Makharia & Vineet Ahuja

  9. AIG Hospitals, Hyderabad, 500 032, India

    Duvvur Nageshwar Reddy

  10. Center of Biostatistics and Evidence Based Medicine, Vellore, 632 004, India

    Richard Kirubakaran

  11. BLK Institute of Digestive and Liver Disease, New Delhi, 201 012, India

    Neha Berry

  12. Aster CMI Hospital, Bengaluru, 560 092, India

    Naresh Bhat

  13. Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India

    Uday Chand Ghoshal & Ujjal Poddar

  14. Choithram Hospital and Research Center, Indore, 452 014, India

    Ajay Jain

  15. Karnataka Gastro Center, Bengaluru, 560 086, India

    Umesh Jalihal

  16. Sri Ramachandra Medical College, Chennai, 600 116, India

    V. Jayanthi

  17. Institute of Digestive and Liver Diseases, BLK - Max Superspeciality Hospital, New Delhi, 201 012, India

    Ajay Kumar

  18. Sawai Man Singh Medical College, Jaipur, 302 004, India

    Sandeep Nijhawan

  19. Aster Medcity, Kochi, 682 027, India

    G. N. Ramesh

  20. Kalinga Gastroenterology Foundation, Cuttack, 753 001, India

    Shivram P Singh

  21. Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, 190 011, India

    Showkat Zargar

  22. Sir H N Reliance Foundation Hospital, Mumbai, 400 004, India

    Shobna Bhatia

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  1. Amit Kumar Dutta
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Contributions

Chairpersons: G Makharia, R Kochhar, S Bhatia, M K Goenka, D N Reddy. Contribution—statement generation, discussion/voting on evidence for statements and recommendation, manuscript review and editing, supervision. Draft committee members: A K Dutta, V Sharma, R Mahajan, M K Panigrahi, V Jearth, Abhinav Jain, Mr. Richard K (expert in application of GRADE). Contribution—statement generation, literature search, application of GRADE, discussion/voting on evidence for statements and recommendation, manuscript writing. Members: U C Ghoshal, U Dutta, V Jayanthi, V Ahuja, S P Singh, A Kumar, N Bhat, S Nijhawan, U Poddar, G N Ramesh, Ajay Jain, S Zargar, N Berry, U Jalihal. Contribution—discussion/voting on evidence for statements and recommendation, manuscript review and editing.

Corresponding author

Correspondence to Amit Kumar Dutta.

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Competing interests

AKD, AJ, VJ, RM, MKP, VS, MKG, RK, GM, DNR, RK, VA, NB, NaB, UD, UCG, AJ, UJ, VJ, AK, SN, UP, GNR, SPS, SZ and SB declare no competing interests.

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Not applicable (the manuscript is an expert guideline and not a clinical research on patients).

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Not applicable (the manuscript is an expert guideline and not a clinical research on patients).

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Not applicable (the manuscript is an expert guideline and not a clinical research on patients).

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Dutta, A.K., Jain, A., Jearth, V. et al. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship. Indian J Gastroenterol 42, 601–628 (2023). https://doi.org/10.1007/s12664-023-01428-7

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