Proton Pump Inhibitor Dosing Patterns Are Less Than Optimal Among New Referrals to an Outpatient Academic Gastroenterology Clinic

Introduction: Proton pump inhibitors (PPI) are a potent class of antisecretory medications widely used in management of several upper gastrointestinal tract diseases including gastro-esophageal reflux disease (GERD) and peptic ulcer disease. Optimal acid suppression occurs when a PPI is taken 30-60 minutes prior to a meal. Previous investigators have suggested that suboptimal PPI dosing is prevalent in patients presenting to gastroenterology (GI) clinics. The study aim was to assess PPI dose timing among patients newly referred to GI clinic at our academic medical center. Methods: All patients presenting for an initial GI clinic visit and on a prescribed PPI were invited to complete a one-page survey on daily PPI dose timing. Surveys were collected from 1 August-31 October 2022. The survey was given to patients for completion with clinic staff on-hand to assist as needed. Information collected included demographic data, specialty of referring physician, specific PPI prescribed, reason for PPI use, medication timing, and satisfaction with therapy prior to the GI clinic visit. Results: A total of 299 patients completed the survey. Mean age was 54.8 years with self-identified race as follows: 51% non-Hispanic White, 41% African American and 8% Hispanic/other. Males were 38% of the group. Referring physician specialty was as follows: Family Medicine 39.5%, Internist 23.7%, GI 17.7% and other 19.1%. All available PPIs were taken with omeprazole most frequent at 54.2%, followed by pantoprazole 32.8% and esomeprazole in 9.7%. The main indication for PPI was GERD in 77.8%. Optimal PPI dosing (within 60 min before a meal) was reported by 46% of respondents (Table 1). On demand/other or at bedtime were the next frequent dose times. For optimal PPI dose timing, no significant difference was seen among patients referred from different specialties (Table 1). Symptom control was perceived as optimal by 43.5% prior to the initial visit. Conclusion: Optimal PPI dose timing prior to an initial GI clinic visit occurred in 46% of respondents. Satisfactory disease/symptom control was reported by 43.5%. This suggests an unmet need for effective patient education by providers or reinforcement of dosing instructions by dispensing pharmacies to maximize benefit. Optimization of PPI dosing is expected to improve patient outcomes via enhanced disease/symptom control, facilitate appropriate PPI dose de-escalation, and reduce unnecessary referrals with their associated costs. Table 1. - PPI dose timing at presentation and by referral source Medication Timing Number Percentage Optimally dosed PPI (0-60min before meals) 138 46% >1hr before meals 20 6.7% After meals 28 9.4% At bedtime 46 15.4% On demand/Other 67 22.4% Total 299 100% Referral Source Total Count Percentage Optimally Dosing PPI (P=0.449) Gastroenterologist 53 59% Family Practice 118 44% Internist 71 42% Other Provider 57 44% Total 299