One study found a fold increased risk of community acquired pneumonia in patients on PPIs. Another found a fold increased odds of hospital-acquired pneumonia in patients on PPIs. Analyses of data from the 845272-21-1 United Kingdom showed a 1.5 fold increased risk of hip fracture with long-term PPI use. Further, MIR96-IN-1 literature also suggests that the benefits of PPIs may be overstated particularly for prophylaxis in hospitalized patients. In fact, a recent literature review found no significant difference in stress ulcer prevalence in hospitalized patients who received H2-blockers and PPIs. If, in fact, such a high percentage of patients are on PPIs for no reason, we may be putting patients at undue risk. Our study is limited primarily by the data available through the NAMCS and NHAMCS. First, our evaluation is at the visit level, not at the patient level so the percentages we report of percent of visits, not percent of patients. It is possible that there is not a direct correlation between the number of patients on PPIs and their use documented at the visit level or it is possible that patients on PPIs have more visits than patients not on PPIs. We did, however, look at trends across years and documented medication use, diagnoses, and symptoms at the visit level for multiple years. Second, our data are limited to what is documented from the patient record. Although the surveys do ask for over-the-counter medications, it is possible that PPIs that are available over-the-counter may not be documented in the patient record. Conversely, we may be overestimating potentially inappropriately used PPIs because not all symptoms, diagnoses, and medications are documented in NAMCS and NHAMCS. We also do not know whether PPIs were prescribed on an as needed basis or the duration of therapy. Lastly, it is possible that patients remain on PPIs long-term because of rebound symptoms when they are removed from PPIs. In summary, we found a large and significant increase in PPI use in the U.S. outpatient setting since 2002 but no increase in PPI use without a documented indication or in new PPI prescriptions. Nevertheless, the majority of patients on PPIs in all years had no documented indication. Our findings confirm what has been documented in sma
