BACKGROUND: Proton pump inhibitors have numerous important side effects, yet they are prescribed for outpatients who do not have recognized indications. Less is known with respect to prescribing for inpatients. OBJECTIVE: To determine the rate of inappropriate prescribing of protein pump inhibitors and to assess reasons why they are prescribed.

As long-term survival after liver transplantation increases, metabolic complications are becoming increasingly prevalent. Given concerns about which group of providers should be managing liver recipients and how well metabolic complications are managed, we administered a postal survey to 280 transplant hepatologists to determine attitudes, perceptions, and practice patterns in the management of metabolic complications after transplantation. The response rate was 68.2%. There was great variation in patterns of practice across the United States with respect to the number of posttransplant clinics, clinic format, and number of recipients cared for per week. Hepatologists, primary care physicians (PCPs), and surgeons were primarily responsible for the overall care of liver recipients 1 year or more after liver transplantation according to 66%, 24%, and 8% of respondents, respectively. Hepatologists felt that metabolic complications were common, but few strongly agreed that hypertension (33.3%), chronic renal insufficiency (3.8%), diabetes mellitus (8.8%), dyslipidemia (11.1%), and bone disease (12.8%) were well controlled. The majority of hepatologists indicated that ideally PCPs should be managing recipients' hypertension, diabetes mellitus, dyslipidemia, and bone disease (78.8%, 63.1%, 78.3%, and 72.5%), but they felt that in actuality, PCPs were managing these conditions less frequently (45.4%, 51.4%, 44.6%, and 38%). In conclusion, metabolic complications are perceived to be common but not well controlled post-transplant, and most hepatologists feel that PCPs should take a more active role in the management of these complications. Future studies are needed to identify barriers to care in the treatment of metabolic complications post-transplant with the goal of improving long-term morbidity and mortality. Liver See Editorial on Page 1162Approximately 6000 liver transplants are performed each year in the United States. Since the era of liver transplantation began in 1963, survival after liver transplantation has significantly improved, with overall 1-and 5-year patient survival rates of 86.9% and 73.6%, respectively.1 As long-term survival increases, cardiovascular complications are emerging as major causes of morbidity and mortality. The negative impact of cardiovascular disease on liver transplant recipients has only recently been addressed; recent data indicate that accelerated cardiovascular disease is second only to malignancy as a cause of late mortality in liver transplant patients. 2As more transplant recipients survive into their first and second decades post-transplant, it is likely that more will develop metabolic complications such as hypertension (HTN), chronic renal insufficiency (CRI), diabetes mellitus (DM), dyslipidemia (LIPIDS), obesity,

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Modern endoscopy affords good localization of the bleeding site and successful treatment for most patients with upper GI bleeding.