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Table 1 Summary of the conclusions by Scarpignato et al. [3] regarding the appropriateness of proton pump inhibitor (PPI) therapy in 13 clinical scenarios of uncertainty and common misuse

From: When is proton pump inhibitor use appropriate?

  Reason for use
Long-term PPI therapy appropriate • Barrett’s esophagus
• Healing and maintenance of healed Los Angeles grade C or D erosive esophagitisa
• PPI-responsive esophageal eosinophilia
• Idiopathic (H. pylori and NSAID/aspirin negative) peptic ulcer disease
• Zollinger–Ellison diseasea,b
• PPI-responsive GERD/non-erosive reflux diseasea,c
• Long-term non-selective NSAID users at high-risk for upper GI complications or long-term cox-2 inhibitor users with a prior episode of GI bleedinga
• Anti-platelet therapy in patients at high-risk for upper GI complications (age > 65 years or concomitant use of corticosteroids or anticoagulants or history of peptic ulcer disease)
• Steatorrhea refractory to enzyme replacement therapy in chronic pancreatitis
Short-term PPI therapy appropriate (4- to 12-week course) • Healing of Los Angeles grade A or B erosive esophagitisa
• Eosinophilic esophagitis
• H. pylori eradication (in combination with antibiotics)a,d
• Stress ulcer prophylaxis in high-risk patients (i.e., critically ill patients with respiratory failure or coagulopathy)
• Functional dyspepsia
• Treatment and maintenance of peptic ulcer diseasea
• Prior to endoscopy for acute upper GI bleeding
• Following endoscopic treatment of a high-risk ulcer GI bleed
PPI use not appropriate • Corticosteroid users without concomitant NSAID therapy
• To prevent bleeding from hypertensive gastropathy in cirrhotic patients
• Acute pancreatitis
• Stress ulcer prophylaxis in non-critically ill hospitalized patients that are not at high-risk for ulcer formation and GI bleeding
PPI use of uncertain benefit • PPI non-responsive GERD
• Extra-digestive GERD
  1. aFDA approved indications
  2. bRequires 3–4 times the usual dose (PPI therapy is typically started as single dose)
  3. cIn these cases, a PPI taper should be attempted to the lowest effective dose, on demand dosing, or intermittent dosing
  4. dIn this case, a 1 to 2 week course of PPI therapy for H. pylori eradication in conjunction with antibiotics is appropriate
  5. GERD gastroesophageal reflux disease, GI gastrointestinal, NSAID non-steroidal anti-inflammatory drugs