Appropriateness of Proton Pump Inhibitor Prescription Evaluated by Using Serological Markers

Background: Inappropriate prescription of proton pump inhibitors (PPI) has been widely reported, often lacking initial exclusion of Helicobacter pylori (HP) infection and evaluation of gastric functional status. The aim of this study was to evaluate the utility of gastric functional tests to define the acid output as well as HP status in patients in order to better direct PPI-therapy prescription. Methods: Dyspeptic patients without alarm symptoms from a primary care population were evaluated. For each patient serum Pepsinogen I (PGI) and II (PGII), Gastrin 17 (G17) and an ti-HP IgG antibodies (Biohit, Oyj, Finland) were determined. For each subject, data was collected regarding symptoms, past medical history of HP infection and PPI use. Therapeutic response to PPIs was determined according to PGI and G17 values, where G17>7 in the presence of elevated PGI and absence of CAG, was considered an adequate response. Results: Among 2583 dyspeptic patients, 1015/2583 (39.3%) were on PPI therapy for at least three months before serum sampling, and were therefore included in the study. Active HP infection and CAG were diagnosed in 206 (20.2%) and 37 (3.6%) patients, respectively. Overall, a good therapeutic response to PPIs was ob served in 34.9%, reaching 66.7% at the highest dose. However, 41.1% and 20.4% of patients showed low (G17 1-7) or absent (G<1) response to PPI, regardless of the dosage used. Conclusions: Ac cording to gastric functional response, most patients currently on PPI maintenance therapy lack a proper indication for continuing this medication, either because acid output is absent (as in CAG), or because gastrin levels fail to rise, indicating absence of gastric acid negative feedback. Lastly, HP eradication is warranted in all patients, and gastric function testing ensures this pathogen is sought for and adequately treated prior to initiating long-term PPI therapy.