Most of us will have experienced heartburn at some point. Heartburn occurs when stomach acid or food refluxes from the stomach into the oesophagus, causing a painful burning sensation. If you only have heartburn every so often, you might tough it out or take an over-the-counter ‘antacid’ drug, which neutralises the acid in your stomach and prevents it from burning.

But if you get heartburn often, your doctor might recommend you take a ‘proton-pump inhibitor,’ or PPI. These are medications with brand names like Nexium or Losec and reduce acid in the stomach to very low levels and can be very effective at combating the burning sensation in the chest. Trouble is, long-term use of PPIs can be harmful.

The concerns around their extended use are that they may lead to increased risk of bone fractures, vitamin B and magnesium deficiencies, and infection with Clostridium difficile bacteria, which can cause serious bowel damage and in some vulnerable people, lead to an increased risk of premature death.

To try and responsibly reduce the number of PPI medications used in Australia, researchers developed and evaluated a year-long educational program targeted at general practitioners, to tell them about the possible risks of long-term PPI use. It also communicated to the public.

The researchers then looked at the prescribing trends of PPIs between 2012 and 2018. The educational intervention was delivered in 2015 and 2016, and the researchers did see a small decline in PPI prescription during that time – about a two per cent decrease. But many Australians continued to use high-strength PPIs over the years and showed no signs of slowing down.

Implications

Getting people to reduce their medication use is a tricky business. Once you’ve started something and it seems to help, it becomes difficult to stop.

This study shows that educational initiatives seem to have a limited effect, even when implemented on a wide scale. If you are using PPIs and have been for an extended time, it might be useful to have a conversation with your GP about other medications you might consider, whether it’s possible to reduce the strength of your drug or whether in fact, you’d be better off having surgery to fix the problem.

Last Reviewed: 18/07/2020

© Norman Swan Medical Communications.



References

For reference: Bruno, et al (2019). Passing the acid test? Evaluating the impact of national education initiatives to reduce proton pump inhibitor use in Australia. BMJ Quality & Safety doi:10.1136/bmjqs-2019-009897.

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