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Less Is More
May 10, 2010

Failing the Acid Test: Benefits of Proton Pump Inhibitors May Not Justify the Risks for Many Users

Arch Intern Med. 2010;170(9):747-748. doi:10.1001/archinternmed.2010.64

Financial Disclosure: Dr Katz is an independent consultant for Health Management Associates.

A staggering 113.4 million prescriptions for proton pump inhibitors (PPIs) are filled each year, making this class of drugs, at $13.9 billion in sales, the third highest seller in the United States.1 These medications are effective for treatment of erosive and ulcerative esophagitis, Barrett esophagus, Zollinger-Ellison syndrome, and gastroesophageal reflux disease (GERD), as well as for short-term treatment of ulcer disease, as part of a combination regimen for Helicobacter pylori eradication and for prevention of ulcers due to nonsteroidal anti-inflammatory drugs.2 However, these indications do not account for more than a hundred million prescriptions. So it should come as no surprise that PPIs have been shown to be overprescribed3; between 53% and 69% of PPI prescriptions are for inappropriate indications.2,4,5

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