Proton pump inhibitor use: systematic review of global trends and practices

Abstract

Purpose: Proton pump inhibitors (PPIs) reduce acid secretion in the stomach and rank as one of the most widely used acid-suppressing medicines globally. While PPIs are safe in the short-term, emerging evidence shows risks associated with long-term use. Current evidence on global PPI use is scarce. This systematic review aims to evaluate global PPI use in the general population.

Methods: Ovid MEDLINE, Embase, and International Pharmaceutical Abstracts were systematically searched from inception to 31 March 2023 to identify observational studies on oral PPI use among individuals aged ≥ 18 years. PPI use was classified by demographics and medication factors (dose, duration, and PPI types). The absolute numbers of PPI users for each subcategory were summed and expressed as a percentage.

Results: The search identified data from 28 million PPI users in 23 countries from 65 articles. This review indicated that nearly one-quarter of adults use a PPI. Of those using PPIs, 63% were less than 65 years. 56% of PPI users were female, and "White" ethnicities accounted for 75% of users. Nearly two-thirds of users were on high doses (≥ defined daily dose (DDD)), 25% of users continued PPIs for > 1 year, and 28% of these continued for > 3 years.

Conclusion: Given the widespread use PPIs and increasing concern regarding long-term use, this review provides a catalyst to support more rational use, particularly with unnecessary prolonged continuation. Clinicians should review PPI prescriptions regularly and deprescribe when there is no appropriate ongoing indication or evidence of benefit to reduce health harm and treatment cost.

Keywords: Dose; Global use; Long term; Proton pump inhibitors; Systematic review.

Fig. 1

Flowchart of eligible study identification

Fig. 2

Global regions where PPI utilisation data were available

Fig. 3

Percentage of PPI users included in this review, stratified by age groups. Total users’ (prevalent users + new users) data from 26 studies (N = 6,382,619); new users’ data from 15 studies (N = 5,060,973). *Excluded, i.e., age categories reported in eligible studies were outside the age bands used for this analysis (e.g., < 55, > 45, and 18–65) (all users = 4.2% and incident users = 3.2%)

Fig. 4

Numbers of people who used PPIs included in this review, stratified by duration groups. Total users’ (prevalent users + new users) data from 22 studies (N = 5,266,213); percentage of short-term users (< 1 year) vs. long-term users (≥ 1 year) (67.4% vs. 25.1%). New users’ data from 5 studies (2,450,952); percentage of short-term users (< 1 year) vs. long-term users (≥ 1 year) (80.9% vs. 18.9%; P < 0.001). *Excluded, i.e., duration categories reported in eligible studies were outside the duration bands used for this analysis (e.g., > 8 weeks, > 3 months, and 6–24 months) (all users = 1.3% and incident users = 0.2%)