Proton pump inhibitors (PPIs) are widely prescribed in acute gastrointestinal bleeding (AGIB), but inappropriate overuse or underuse remains common. Their true effect on short- and long-term outcomes is still debated, especially in low-resource settings where PPI stewardship is limited. No prior Moroccan study has assessed PPI utilization patterns in AGIB.

Aim

To evaluate PPI utilization on admission and at discharge in patients presenting with overt AGIB, and to determine their impact on short-term (1-month) and long-term outcomes in a tertiary Moroccan center.

A prospective monocentric study was conducted at CHU Mohammed VI Marrakech from January 2022 to January 2025, including 240 patients admitted with overt AGIB. Data collected included PPI use, antithrombotic therapy, clinical severity, endoscopic findings, and short- and long-term outcomes. Univariate and multivariate analyses identified predictors of mortality and rebleeding.

PPI utilization

40% of patients were already on PPI at admission.

72% were discharged on PPI.

Overall PPI overutilization rate: 32% (patients without clear indication).

Underutilization rate: 21% (patients with clear indication but no PPI at discharge).

Characteristics of patients on PPI at admission

Compared with those not on PPI, patients on PPI were:

older (median 69 vs 63 years)

had higher comorbidity burden (higher CCI)

more likely to be on antithrombotics

more likely to require blood transfusionBut they had:

fewer stigmata of recent hemorrhage

reduced need for endoscopic therapy

Outcomes

1-month rebleeding: similar whether PPI was used on admission or not.

1-month mortality: slightly higher in PPI users, but PPI itself was not an independent predictor on multivariate analysis.

Independent predictors of 1-month mortality

Higher Charlson Comorbidity Index

Severe bleeding

Need for blood transfusion

Stigmata of recent hemorrhage

Independent predictors of 1-month rebleeding

Anticoagulant use on admission

Severe bleeding

SRH on endoscopy

Long-term outcomes

PPI use at discharge did not predict long-term mortality or rebleeding.Anticoagulant therapy at discharge predicted long-term mortality, while antiplatelet therapy was protective against long-term rebleeding.

In this 3-year Moroccan monocentric cohort, PPI overutilization and underutilization were both frequent, reflecting the absence of standardized PPI stewardship.However, PPI use had no significant impact on short-term or long-term mortality or rebleeding.

These findings highlight the need for a PPI utilization stewardship program to optimize prescribing practices, reduce unnecessary costs, and minimize adverse effects associated with inappropriate long-term PPI exposure.