Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly.

Background: Proton pump inhibitors (PPI) are among the most commonly prescribed medicines and their
overuse is widespread in both primary and secondary care. Inappropriate prescription is of particular concern
among elderly patients, who have often multiple comorbidities and need many drugs.
Methods: We evaluate the appropriateness of drugs for peptic ulcer or gastro-esophageal reflux disease
(GERD) in a sample of elderly patients (65 years old or older) at admission and discharge in 38 internal
medicine wards between January 2008 and December 2008, according to the presence of specific conditions
or gastro-toxic drug combinations.
Results: Among 1155 patients eligible for the analysis, 466 (40.3%) were treated with drugs for GERD or peptic
ulcer were at hospital admission and 647 (56.0%) at discharge; 62.4% of patients receiving a drug for peptic
ulcer or GERD at admission and 63.2% at discharge were inappropriately treated. Among these, the number of
other drugs prescribed was associated with greater use of drugs for peptic ulcer or GERD, even after
adjustment for age, sex and number of diagnoses at admission (OR 95% CI=1.26 (1.18–1.34), p=.0001) or
discharge (OR 95% CI=1.11 (1.05–1.18), p=0.0003).
Conclusions: Prevalence of inappropriate prescription of drugs for peptic ulcer or GERD remained almost the
same at admission and discharge. Inappropriate use of these drugs is related to the concomitant use of other
drugs. Careful assessment of clinical conditions and stricter adherence to evidence-based guidelines are
essential for a rational and cost-effective use of drugs for peptic ulcer or GERD.