Introduction: High-intensity proton pump inhibitor (PPI) use is often recommended by physicians, though there is little proven benefit over standard PPI dosing in many clinical situations. We therefore sought to calculate the prevalence and predictors of high-intensity PPI use.
Methods: We used a Canadian provincial administrative database to capture all PPI prescriptions between 1996 and 2004. A person was defined as a high-intensity user if he used PPIs at more than 1.5 times the standard PPI dose for greater than 45 of 90 days before the index date. The prevalence of high-intensity use was calculated at four index dates annually. Stepwise logistic regression was performed to determine clinical and demographic factors associated with high-intensity PPI use.
Results: The prevalence of high-intensity PPI use increased from 9.7% in 1997 to 14.2% in 2004. Polypharmacy, concomitant use of antispasmodic/promotility agents, and recent endoscopy were most strongly predictive of high-intensity PPI use. Severity of gastroesophageal reflux disease (GERD) (as assessed by the number of GERD-related physician visits) was relatively weakly predictive of high-intensity PPI use.
Conclusions: High-intensity PPI use is becoming more prevalent over time, and its use is strongly associated with factors suggestive of a high degree of comorbidity and treatment failure. Further research into factors that drive high-intensity PPI prescription and use are required.