Patients' perception of proton pump inhibitors use and their risks

Long-term proton pump inhibitor (PPI) therapy is widely prescribed for acid-related disorders. Emerging evidence associates prolonged use with potential adverse outcomes, including gastric cancer. Despite increasing prescriptions, little is known about patients' awareness of these risks or factors influencing discontinuation. We hypothesized that limited risk awareness and family support significantly affect patients' willingness to deprescribe PPIs.

To evaluate patients' awareness of PPI risks and factors associated with deprescribing.

A cross-sectional observational study was conducted in community clinics and pharmacies across Israel, including 3000 adult PPI users recruited consecutively. Participants completed a multilingual survey (Hebrew, Arabic, Russian) assessing risk awareness, family support, and quality of life. A composite risk scale (0-12) was used to quantify perceived cancer risk. Descriptive statistics and multivariate logistic regression were performed to identify factors associated with high-risk awareness and willingness to discontinue PPIs.

Among 3000 participants, fatigue occurred in 20%, constipation in 31.3%, infections in 9.3%, renal issues in 4.6%, and no side effects in 12.5%. Pantoprazole cancer-risk perception was 26.5%. Overall, 30% desired to discontinue PPIs and 15% reported symptom recurrence. High composite risk score (≥ 2) was associated with family support [odds ratio (OR) = 1.9, 95% confidence interval (CI): 1.3-2.8; P < 0.01] and longer PPI use (> 1 year; OR = 1.6, 95%CI: 1.1-2.4; P = 0.02). Attempted discontinuation correlated with high-risk score (OR = 2.1, 95%CI: 1.5-3.0; P < 0.001).

Patients show limited awareness of long-term PPI risks. Family support and longer treatment duration are strongly associated with higher risk awareness and willingness to discontinue PPIs.