Use of proton pump inhibitors in general practice

Table 1 Rules of the Italian Drug Agency for the refund of proton pump inhibitor drugs

The prescription of PPI refundable by the National Health Service is limited to
The prevention of serious complications of the upper gastrointestinal tract in patients in chronic treatment with NSAIDS or in antiaggregant therapy with low doses of ASA, provided there is one of the following conditions of risk: (1) history of past digestive hemorrhage or peptic ulcer not healed with Helicobacter pylori treatment; (2) concomitant therapy with anticoagulants or cortisone; and (3) advanced age
Duration of treatment 4 wk (occasionally 6 wk): Duodenal or gastric ulcer, in association with drugs eradicating the infection; GERD with or without esophagitis (first episode)
Duration of treatment extended to reevaluate after one year: Zollinger-Ellison syndrome; relapsing duodenal or gastric ulcer; GERD with and without esophagitis (relapsing)

PPI: Proton pump inhibitor; GERD: Gastroesophageal reflux disease; ASA: Acetylsalicylic acid; NSAIDS: Non-steroidal ant-inflammatory drugs.

Table 2 Characteristics of proton pump inhibitor-users (at least 3 packs in 90 d) and non-proton pump inhibitor-users n (%)

	All	PPI-users	Non PPI users
Patients	42548	6322	36226
Males	19632 (46.1)	2520 (39.9)	17112 (47.2)
Aged over 64 yr	12084 (28.4)	3902 (61.7)	8182 (22.6)
GERD	5769 (13.6)	2980 (47.1)	2789 (7.7)
Peptic ulcer	689 (1.6)	375 (5.9)	314 (0.9)
Arthropathy	15661 (36.8)	3786 (59.9)	11875 (32.8)
Heart disease	3932 (9.2)	1674 (26.5)	2258 (6.2)
Neoplasms	3384 (8.0)	1076 (17.0)	2308 (6.4)
Use of NSAIDS	1131 (2.7)	416 (4.6)	715 (2)
Use of ASA	4522 (10.6)	2017 (31.7)	2505 (6.9)
Use of OAT	1127 (2.6)	500 (7.9)	627 (1.7)
Use of systemic steroids	547 (1.3)	306 (4.8)	241 (0.7)
EGD scopy	5772 (13.6)	2626 (41.5)	3146 (8.7)
Test per H. pylori	4761 (11.2)	1641 (26.0)	3120 (8.6)
PPI refundable for prevention of gastric damage by NSAIDS	4105 (9.6)	1896 (30.0)	2209 (6.1)
PPI refundable for peptic ulcer or GERD	6340 (14.9)	3265 (51.6)	3075 (8.5)
PPI refundable for prevention of gastric damage by NSAIDS or peptic ulcer or GERD	9368 (22.0)	4383 (69.3)	4985 (13.8)

All the features differ significantly (P < 0.01) between the two groups. PPI: Proton pump inhibitors; GERD: Gastroesophageal reflux disease; Heart disease: Heart failure, coronary ischemic disease, major heart valves disease; NSAIDS: Non steroid inflammatory drugs; ASA: Acetylsalicylic acid; OAT: Oral anticoagulant therapy; EGDscopy: Esophageal-gastro-duodenal endoscopy; H. pylori: Helicobacter pylori.

Table 3 Characteristics of proton pump inhibitors-users with or without refundable conditions according to the Italian Drug Agency n (%)

	PPI refundable	PPI not refundable	P value
Patients	4383	1939
Males	1762 (40.2)	758 (39.1)	ns
Aged over 64 yr	2967 (67.7)	935 (48.4)	0.01
Arthropathy	2717 (62.0)	1069 (55.1)	0.01
Heart disease	1263 (28.8)	411 (21.9)	0.01
Neoplasms	764 (17.4)	312 (16.1)	ns
Use of NSAIDS	333 (7.6)	83 (4.3)	0.01
Use of ASA	1857 (42.4)	150 (7.7)	0.01
Use of OAT	255 (5.8)	245 (12.6)	0.01
Use of systemic steroids	201 (4.6)	105 (5.4)	ns
EGDscopy	1984 (45.3)	642 (33.1)	0.01
H. pylori test	1232 (28.1)	409 (21.1)	0.01

All the features differ significantly (P < 0.01) between the two groups, except for gender, frequency of neoplasms and use of systemic steroids. PPI: Proton pump inhibitors; GERD: Gastroesophageal reflux disease; Heart disease: Heart failure, coronary ischemic disease, major heart valves disease; NSAIDS: Non steroid inflammatory drugs; ASA: Acetylsalicylic acid; OAR: Oral anticoagulant therapy; ns: Not significant; EGDscopy: Esophageal-gastro-duodenal endoscopy; H. pylori: Helicobacter pylori.