The Use of Proton Pump Inhibitors Among Adults in Norway-A Nationwide Drug Utilization Study

The use of proton pump inhibitors (PPIs) has increased in Western countries over several decades, and there is concern about unsubstantiated indications and effects of long-term use. The study aimed to describe the prevalence, incidence, indications, and prescription pattern for PPIs over the past decade in an entire national cohort. This nationwide drug utilization study used data from the Norwegian Prescription Database and Norwegian Patient Registry. Patterns of PPI use were investigated from 2009 to 2022. Prevalent, long-term, and incident PPI use were calculated. The indication for PPI was defined by the diagnosis code linked to each prescription. Upper endoscopies during the study period were assessed for incident PPI users. PPI prescription increased from 58.1 mill DDD in 2009 to 166.9 mill DDD in 2022, that is, 43 and 106 DDD/1000 inhabitants/day. Prevalent PPI use increased from 3.5% to 9.9%, paralleling an increased incidence from 2.9% to 5.4%. The dominant indications in 2009 and 2022 were esophageal disease in primary care (72.5% and 57.6% of total DDDs) and GERD in specialist care (10.7% and 4.7% of total DDDs). Musculoskeletal disorders, pain, and ulcer prophylaxis all increased during the period. Upper endoscopy around incident PPI use decreased from 25.3% to 11.1%. In conclusion, the 2.46-fold increase in prevalent PPI use was caused by an absolute increase in PPI prescribed against esophageal disease and GERD, and prophylaxis in patients using ulcerogenic comedication, mainly prescribed in primary care. The findings may help inform strategies to reduce a probable overuse of PPIs.