Tratamiento con inhibidores de la bomba de protones. ¿Realmente lo necesita el paciente? / Proton-pump inhibitors treatment. Does your patient really need it?

Introducción: Los inhibidores de la bomba de protones (IBP) son fármacos utilizados frecuentemente para el manejo de diferentes enfermedades gastrointestinales. Aunque sus indicaciones y dosis están bien establecidas, se han comunicado elevadas tasas de maluso. Métodos: Estudio observacional transversal realizado en un servicio de urgencias de un hospital terciario. Pacientes adultos que acudían por distintas patologías fueron invitados a participar. Se evaluó la correcta indicación del IBP, además de su dosis, duración del tratamiento y facultativo prescriptor. Resultados: Se incluyeron 300 pacientes. La indicación se consideró correcta en 142 pacientes (47,3%), siendo la indicación más frecuente la profilaxis de enteropatía inducida por AINE/AAS (n=95; 31,7%). La «gastroprotección» en paciente polimedicados, sin fármacos gastroerosivos fue la principal indicación inadecuada (n=82; 27,3%) seguida de la profilaxis innecesaria en pacientes menores de 60 años tratados en monoterapia con un fármaco gastroerosivo. La mediana del tiempo de prescripción fue de 31 meses (RIC: 9-72) con un intervalo de 1-360 meses. El tiempo de prescripción era inferior en aquellos con indicación correcta (42,3 vs. 59,6 meses, p=0,02). El médico de atención primaria era el prescriptor más frecuente (n=165; 55%), seguido del gastroenterólogo (n=38; 12,7%), sin encontrar diferencias significativas en cuanto a la adecuación de la prescripción. Conclusiones: Estudios como el presente alertan de la persistencia de unas elevadas sobreutilización y maluso de los IBP. La desprescripción, cuando el IBP no está indicado, puede ayudar a controlar el gasto sanitario innecesario y a evitar iatrogenia (AU)

Introduction: Proton-pump inhibitors (PPI) are frequently prescribed for wide gastrointestinal disorders. The indications are well established, although a high rate of misuse has been reported. Methods: Observation cross-sectional study conducted a tertiary hospital. Adult patients who attended the emergency department were eligible. The appropriate indication was evaluated. Also, the prescription period, dosage and the prescribing clinician were reviewed. Results: 300 patients were included. The indication was adequate in 142 patients (47.3%). The main indication was the primary prophylaxis for NSAIDs/ASA-induced enteropathy (n=95 patients, 31.7%). Polypharmacy was the main misuse indication (n=82 patients, 27.3%). The median prescription duration was 31 months (IQR 9-72), ranging from one month to 360 months. The duration was lower in those with correct indication (42.3 vs 59.6 months, P=.02). The primary care physician was the main responsible for prescription (n=165 patients, 55%), followed by gastroenterologist (n=38 patients, 12.7%) without significant differences in appropriateness by speciality. Conclusions: Studies like this raise awareness about the PPI overuse and misuse. Deprescribing should be considered as essential to reduce iatrogenic risk and redundant health expenditure (AU)

[Proton-pump inhibitors treatment. Does your patient really need it?] / Tratamiento con inhibidores de la bomba de protones. ¿Realmente lo necesita el paciente?

INTRODUCTION: Proton-pump inhibitors (PPI) are frequently prescribed for wide gastrointestinal disorders. The indications are well established, although a high rate of misuse has been reported. METHODS: Observation cross-sectional study conducted a tertiary hospital. Adult patients who attended the emergency department were eligible. The appropriate indication was evaluated. Also, the prescription period, dosage and the prescribing clinician were reviewed. RESULTS: 300 patients were included. The indication was adequate in 142 patients (47.3%). The main indication was the primary prophylaxis for NSAIDs/ASA-induced enteropathy (n=95 patients, 31.7%). Polypharmacy was the main misuse indication (n=82 patients, 27.3%). The median prescription duration was 31 months (IQR 9-72), ranging from one month to 360 months. The duration was lower in those with correct indication (42.3 vs 59.6 months, P=.02). The primary care physician was the main responsible for prescription (n=165 patients, 55%), followed by gastroenterologist (n=38 patients, 12.7%) without significant differences in appropriateness by speciality. CONCLUSIONS: Studies like this raise awareness about the PPI overuse and misuse. Deprescribing should be considered as essential to reduce iatrogenic risk and redundant health expenditure.