Deprescribing of proton pump inhibitors in internal medicine in-patients: A retrospective observational study

Proton pump inhibitors (PPI) treat gastrointestinal disorders and are often overprescribed or continued unnecessarily, despite potential long-term adverse effects (e.g. infections). Deprescribing is recommended when indications are unclear or treatment unnecessarily prolonged. In Switzerland, national guidelines on PPI deprescribing are lacking. This study assessed PPI deprescribing frequency, appropriate new prescriptions and possible reasons for not performing deprescribing.

Retrospective study at the Inselspital, Bern, Switzerland. Included were patients ≥18 years admitted to internal medicine wards during January-February 2022 with PPI on admission or newly prescribed during hospitalization. PPI duration and indication were retrieved from electronic health records. Data were evaluated with descriptive statistics and multivariable regression models.

Among 852 admissions, 54% (n = 458) were included (38% female, 72% ≥60 years old). Of them, 70% (n = 320) had PPI on admission and 30% (n = 138) newly prescribed during hospitalization, with appropriate use in 48% (153/320) and 49% (68/138) cases, respectively. At discharge, 376 (82%) of the included cases had PPI, 44% (n = 166) with appropriate use. Among 300 patients with indicated deprescribing, this occurred in 90 (30%) and was less likely with PPI on admission (OR = 0.2, 95% CI:0.1-0.4, p < 0.01). Possible reasons for not performing deprescribing (n = 210) included unmet bleeding prophylaxis criteria (61%, n = 128), unclear re-evaluation plans (8%, n = 17) and outdated indications (7%, n = 15).

Most PPI were continued upon discharge, despite half lacking a clearly appropriate use. Knowledge, communication and information gaps may have contributed to missed deprescribing opportunities. Regular medication reviews across healthcare settings could improve deprescribing practices and ensure appropriate PPI use.