Systematic reviewindependent cross-checkabstract checked I-PPI-119 standard review
A quarter of adults take acid blockers
Proton pump inhibitor use: systematic review of global trends and practices.
Overview
Shanika LGT et al.. Eur J Clin Pharmacol 2023 · PMID 37420019 · DOI 10.1007/s00228-023-03534-z
Data from 23 countries suggest nearly one in four adults uses a PPI, many at high doses and for more than a year.
Does the study support the specific claim? Yes · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Describe global PPI use.
- How was the study done?
Systematic review.
- How many people, animals or samples were studied?
28 million users.
- What was actually found?
~25% of adults; two-thirds high dose; 25% >1 year.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Many people may take PPIs longer than needed.
- What are the study's limitations?
Heterogeneous data.
- What does it say about Elawady's specific claim?
Supports overuse claim.
- Do the results apply to Germany and Europe?
Includes Europe.
- What can explicitly not be concluded from this study?
Does not measure appropriateness directly.
Scientific in-depth review
1. Full reference
- Authors
- Shanika LGT et al.
- Journal
- Eur J Clin Pharmacol
- Year
- 2023
- Identifier
- PMID 37420019 DOI 10.1007/s00228-023-03534-z
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
No competing interests
2. Research question
What is the global pattern of PPI use in adults?
3. Study design and population
- Study design
- Systematic review – Systematic review of observational studies on PPI use patterns
- Population
Adults >=18 in 23 countries
- Country
International
- Period
Search to 31 March 2023
- Sample size
65 articles; 28 million PPI users
- Inclusion and exclusion criteria
Observational studies of oral PPI use
4. Methods and endpoints
- Exposure / intervention
PPI use
- Comparator
Not applicable
- Endpoints
Prevalence, dose, duration
- Statistical methods
Summed proportions
5. Actual results
- Results
Nearly one quarter of adults use a PPI; 63% of users <65 years; nearly two-thirds on high doses (>=DDD); 25% continued >1 year and 28% of these >3 years.
- Absolute risks
Not applicable
- Authors' conclusion
Widespread use; clinicians should review and deprescribe when no ongoing indication exists.
6. Strengths
- Global scope
7. Weaknesses
- Simple summing; heterogeneous sources
- Few low- and middle-income countries
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Descriptive pooling.
9. Assessment of the statistical interpretation
Descriptive.
10. Relevance to the specific claim
Supports the extent of (long-term, high-dose) PPI use underlying C-PPI-11.
11. Independent contrary findings
Use does not equal inappropriate use.
12. Transferability to Germany and Europe
Includes European countries.
13. Overall methodological judgement
Supports overuse concern.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Egyptian data.