Original Article

Utilization of Acid Suppression Medication in an Underserved Population

Authors: Simon Akhnoukh, MD Candidate, Ariel Croker, MD, Gabriel Soliman, BA, Jennifer Acevedo-Giron, BA, Damaris Viera, ARNP, Jose Barboza, PharmD, Karim Hanna, MD


Objectives: Acid suppression therapy (AST), composed of proton pump inhibitors (PPIs), histamine-2 receptor blockers, and antacids, is one of the most common medication groups used in the United States. Long-term AST is concerning, however, because it is linked with an increased risk of community-acquired pneumonia, Clostridium difficile infections, bone fractures, and nutritional deficiencies. The potentially harmful biological and economic consequences associated with the improper use of acid suppression medications presents a great deal of risk to those in underserved communities. We sought to determine the prevalence of AST in an underserved population and the common diagnoses and symptoms associated with therapy. In addition, we studied the frequency of suboptimal usage of PPIs in an indigent care population and the potential factors related to high-risk behaviors.

Methods: The study was a cross-sectional study using a survey that was distributed to participants during their regularly scheduled visits to a public sector provider of health care for low-income patients.

Results: Of the 176 participants surveyed, 70 (40%) were using AST. Esophagitis and gastroesophageal reflux disease were the most prevalent in our sample population. PPIs were the most common acid suppression medication used in our population. Of those using PPIs, 85% were never instructed to cease use. Of the 27 patients with PPI prescriptions, 26 used it in a suboptimal manner, and of those without prescriptions, 7 used it in a suboptimal manner.

Conclusions: ASTs are prevalent in low-income populations, and patients are not being managed appropriately to minimize their risk for complications of AST.
Posted in: Gastroenterology15

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1. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012;143:1179-1187.e3.
2. Antunes C, Curtis SA. Gastroesophageal Reflux Disease. Treasure Island, FL:StatPearls Publishing; 2019.
3. Shaheen NJ, Hansen RA, Morgan DR, et al. The burden of gastrointestinal and liver diseases. Am J Gastroenterol 2006;101:2128-2138.
4. Reid M, Keniston A, Heller JC, et al. Inappropriate prescribing of PPIs. J Hosp Med 2012;5:421-425.
5. Levin TR, Schmittdiel JA, Kunz K, et al. Costs of acid-related disorders to a health maintenance organization. Am J Med 1997;103:520-528.
6. Sarkar M, Hennessy S, Yang YX. Proton-pump inhibitor use and the risk for community-acquired pneumonia. Ann Intern Med 2008;149:391-398.
7. Vestergaard P, Rejnmark L, Mosekilde L. Proton pump inhibitors, histamine h(2) receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int 2006;79:76-83.
8. Gray SL, LaCroix AZ, Larson L, et al. Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women. Arch Intern Med 2010;170:765-771.
9. Ito T, Jensen RT. Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep 2010;12:448-457.
10. Jayatilaka S, Shakov R, Eddi R, et al. Clostridium difficile infection in an urban medical center: five-year analysis of infection rates among adult admissions and association with the use of proton pump inhibitors. Ann Clin Lab Sci 2007;37:241-247.
11. Wei L, Ratnayake L, Phillips G, et al. Acid-suppression medications and bacterial gastroenteritis: a population-based cohort study. Br J Clin Pharmacol 2017;83:1298-1308.
12. Judeo Christian Health Clinic. Home page. https://www.judeochristianhealthclinic.org/index.html. Accessed June 19, 2019.
13. Welage LS, Berardi RR. Evaluation of omeprazole, lansoprazole, pantoprazole, and rabeprazole in the treatment of acid-related diseases. J Am Pharm Assoc 2000;40:52-62.
14. National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Clinical guideline CG184. https://www.nice.org.uk/guidance/cg184/chapter/1-Recommendations#interventions-for-gastro-oesophageal-reflux-disease-gord-2. Published September 2014. Accessed June 19, 2019.
15. Lazarus B, Chen Y, Wilson FP, et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med 2016;176:238-246.
16. El-Serag HB, Sweet S, Winchester CC, et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014;63:871-880.
17. Jacobson BC, Ferris TG, Shea TL, et al. Who is using chronic acid suppression therapy and why? Am J Gastroenterol 2003;98:51-58.
18. Sandhu DS, Fass R. Current trends in the management of gastroesophageal reflux disease. Gut Liver 2018;12:7-16.
19. Nardino RJ, Vender RJ, Herbert PN. Overuse of acid-suppressive therapy in hospitalized patients. Am J Gastroenterol 2000;95:3118-3122.
20. Smith Z, Sifuentes H, Ehrenpreis E. Indications for inpatient use of proton pump inhibitors. Am J Gastroenterol 2011;106:S41-S42.
21. Sheikh I, Waghray A, Waghray N, et al. Consumer use of over-the-counter proton pump inhibitors in patients with gastroesophageal reflux disease. Am J Gastroenterol 2014;109:789-794.
22. Yadlapati R, Kahrilas PJ. When is proton pump inhibitor use appropriate? BMC Med 2017;15:36.