Appropriateness of Proton Pump Inhibitor (PPI) Use in Clinical Practice: A Review Article

The evidence reviewed here indicates that, despite clear guidelines defining appropriate indications for PPI therapy, inappropriate and prolonged use remains common across inpatient, outpatient, and critical care settings worldwide[1,7,9,10,11]. This gap between guideline recommendations and everyday clinical practice appears to be driven by a combination of prescriber habits, systemic prescribing defaults, and patient expectations, rather than any single identifiable cause, suggesting that effective interventions will need to be multifaceted rather than targeted at prescribers alone. Much of the evidence linking long-term PPI use to adverse outcomes such as chronic kidney disease, fracture, and dementia is derived from observational cohort studies, which are inherently susceptible to confounding by indication and residual confounding, since patients requiring long-term acid suppression may differ systematically from those who do not in ways that independently affect these outcomes [14,15,27]. This does not negate the clinical relevance of these associations, but it does mean that the absolute risk attributable to PPI therapy itself, as opposed to underlying patient characteristics, remains difficult to quantify precisely, and clinicians should communicate this uncertainty when counselling patients rather than presenting these risks as definitively causal. This review has several limitations. As a narrative rather than systematic review, study selection and synthesis were not governed by a pre-registered protocol or formal quality-appraisal instrument, and publication bias favouring studies reporting significant associations cannot be excluded. Included studies were heterogeneous in design, setting, and population, limiting direct comparability of the reported prevalence estimates for inappropriate use. Restriction to English-language publications may also have excluded relevant regional data. Future research would benefit from prospective, adequately powered studies designed specifically to quantify the independent contribution of PPI therapy to adverse outcomes, alongside pragmatic trials evaluating the real-world effectiveness of stewardship interventions such as electronic prescribing alerts and pharmacist-led deprescribing programs in reducing inappropriate use without compromising care for patients who genuinely require long-term therapy. Proton Pump Inhibitors remain essential medications in the management of acid-related gastrointestinal disorders. However, inappropriate prescribing and prolonged use have become increasingly common in clinical practice. Irrational use of PPIs contributes to unnecessary healthcare costs, polypharmacy, adverse drug reactions, and increased risk of serious complications such as chronic kidney disease, fractures, and infections. Evidence from recent studies indicates that a significant proportion of PPI prescriptions lack appropriate clinical indications. Therefore, clinicians must adhere strictly to evidence-based guidelines while prescribing PPIs. Regular review of therapy, proper documentation of indications, and implementation of deprescribing protocols are crucial steps toward improving rational use. Promoting awareness among healthcare professionals regarding the risks associated with unnecessary long-term PPI therapy can help optimize patient outcomes and reduce avoidable complications. Rational prescribing practices will ensure that PPIs continue to provide maximum therapeutic benefit while minimizing potential harm. Continued research into the comparative safety of individual agents, combined with wider implementation of stewardship and deprescribing programs, will be essential to closing the persistent gap between guideline recommendations and everyday prescribing practice.

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