Risk of long‑term antisecretory treatment with proton pump inhibitors
Authors:
R. Kroupa; Jiří Dolina
Authors‘ workplace:
Interní hepatogastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jan Lata, CSc.
Published in:
Vnitř Lék 2010; 56(2): 115-119
Category:
Reviews
Overview
At present, pharmacotherapy leading to a reduction in hydrochloric acid production in the stomach constitutes the core treatment strategy for the majority of the upper intestinal tract diseases. Proton pump inhibitors (PPIs) are the predominant therapeutic group. Gastroesophageal reflux disease is the main indication for the long‑term PPI use. Chronic use might be associated with adverse reactions. Potential risks take a form of malabsorption of certain food nutrients with their consequent deficiency, bacterial overgrowth and increased incidence of infections as well as altered regulation of proliferation of gastric as well as other mucosas. Individual risks are low; their assessment is mostly based on the results of population studies. Even though the treatment benefits outweigh any potential theoretical risks, it is wise to decide well on the correct indication and to prescribe the lowest effective dose.
Key words:
proton pump inhibitors – antacids – gastroesophageal reflux disease – treatment – adverse events
Sources
1. Jirásek V. Acidopeptická onemocnění – hlavní indikace pro inhibitory protonové pumpy. Interní Med 2008; 10: 277– 280.
2. Boparai V, Rajagopalan J, Triadafilopoulos G. Guide to the use of proton pump inhibitors in adult patients. Drugs 2008; 68: 925– 947.
3. Lukáš K, Bureš J, Drahoňovský V et al. Refluxní choroba jícnu. Standardy České gastroenterologické společnosti – aktualizace 2009. Čes a Slov Gastroent a Hepatol 2009; 63: 76– 85.
4. Savarino V, Di Mario F, Scarpignato C.Proton pump inhibitors in GORD. An overview of their pharmacology, efficacy and safety. Pharmacological Res 2009; 59: 135– 153.
5. Lazzaroni M, Porro GB. Management of NSAID‑induced gastrointestinal toxicity: focus on proton pump inhibitors. Drugs 2009; 69: 51– 69.
6. Yeomans N, Lanas A, Labenz J et al. Efficacy of esomeprazole (20 mg once daily) for reducing the risk of gastroduodenal ulcers associated with continuous use of low‑dose aspirin. Am J Gastroenterol 2008; 103: 2465– 2473.
7. O’Donoghue ML, Braunwald E, Antman EM et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton‑ pump inhibitor: an analysis of two randomised trials. Lancet 2009; 374: 989– 997.
8. Sibbing D, Morath T, Stegherr J et al. Impact of proton pump inhibitors on the antiplatelet effects of clopidogrel. Thromb Haemost 2009; 101: 714– 719.
9. Gilard M, Arnaud B, Cornily JC et al. Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: the randomizes, double blind OCLA (Omeprazole CLopidogrel Aspirin) study. J Am Coll Cardiol 2008; 51: 256– 260.
10. Bureš J. Helicobacter pylori a nesteroidní antiflogistika. In: Špičák J (ed). Novinky v gastroenterologii a hepatologii. Praha: Grada 2008: 119– 150.
11. Seifert B. Rizika a prevence nežádoucích účinků NSA na trávicí trakt u starších osob. Čes Ger Rev 2007; 5: 72– 77.
12. Piper JM, Ray WA, Daugherty JR et al. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti‑inflammatory drugs. Ann Intern Med 1991; 114: 735– 740.
13. Conn HO, Poynard T. Corticosteroids and peptic ulcer: meta‑analysis of adverse events during steroid therapy. J Intern Med 1994; 236: 619– 632.
14. Delaney B, Ford AC, Forman D et al. Initial management strategies for dyspepsia. Cochrane Database Syst Rev 2005; 4: CD001961.
15. Talley NJ, Vakil N. Practice Parameters Committee of the American College of Gastroenterology. Guidelines for the management of dyspepsia. Am J Gastroenterol 2005; 100: 2324– 2337.
16. Shi S, Klotz U. Proton pump inhibitors: an update of their clinical use and pharmacokinetics. Eur J Clin Pharmacol 2008; 64: 935– 951.
17. West AR, Oates PS. Mechanisms of heme iron absorption: Current questions and controversies. World J Gastroenterol 2008; 14: 4101– 4110.
18. McColl KE. Effect of proton pump inhibitors on vitamins and iron. Am J Gastroenterol 2009; 104 (Suppl 2): S5– S9.
19. Pohl D, Fox M, Fried M et al. Do we need gastric acid? Digestion 2008; 77: 184– 197.
20. Hutchinson C, Geissler CA, Powell JJ et al. Proton pump inhibitors suppress absorption of dietary non‑haem iron in hereditary haemochromatosis. Gut 2007; 56: 1291– 1295.
21. Hirschowitz BI. Vitamin B12 deficiency in hypersecretors during long‑term acid suppression with proton pump inhibitors. Aliment Pharmacol Ther 2008; 27: 1110– 1121.
22. DuPont HL. Systematic review: prevention of travellers’ diarrhoea. Aliment Pharmacol Ther 2008; 27: 741– 751.
23. Leonard J, Marshall JK, Moayyedi P et al. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol 2007; 102: 2047– 2056.
24. Dalton BR, Lye‑ Maccannell T, Henderson EA et al. Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low‑ endemicity, non‑outbreak hospital setting. Aliment Pharmacol Ther 2009; 29: 626– 634.
25. Sarkar M, Hennessy S, Yang YX. Proton‑ pump inhibitor use and the risk for community‑ acquired pneumonia. Ann Intern Med 2008; 149: 391– 398.
26. Herzig SJ, Howell MD, Ngo LH et al. Acid‑ suppressive medication use and the risk for hospital‑ acquired pneumonia. JAMA 2009; 301: 2120– 2128.
27. Insogna KL. The effect of proton pump‑inhibiting drugs on mineral metabolism. Am J Gastroenterol 2009; 104 (Suppl 2): S2– S4.
28. Wright MJ, Proctor DD, Insogna KL et al. Proton pump‑inhibiting drugs, calcium homeostasis, and bone health. Nutr Rev 2008; 66: 103– 108.
29. Yang YX, Lewis JD, Epstein S et al. Long‑term proton pump inhibitor therapy and risk of hip fracture. JAMA 2006; 296: 2947– 2953.
30. Kaye JA, Jick H. Proton pump inhibitor use and risk of hip fractures in patients without major risk factors. Pharmacotherapy 2008; 28: 951– 959.
31. Vestergaard P, Rejnmark L, Mosekilde L. Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int 2006; 79: 76– 83.
32. Targownik LE, Lix LM, Metge CJ et al. Use of proton pump inhibitors and risk of osteoporosis‑related fractures. CMAJ 2008; 179: 319– 362.
33. Sanduleanu S, Stridsberg M, Jonkers D et al. Serum gastrin and chromogranin A during medium- and long‑term acid suppressive therapy: a case- control study. Aliment Pharmacol Ther 1999; 13: 145– 153.
34. Laine L, Ahnen D, McClain C et al. Review article: potential gastrointestinal effects of long‑term acid suppression with proton pump inhibitors. Aliment Pharmacol Ther 2000; 14: 651– 668.
35. Kuipers EJ. Proton pump inhibitors and gastric neoplasia. Gut 2006; 55: 1217– 1221.
36. Malfertheiner P, Megraud F, O’Morain C et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007; 56: 772– 781.
37. Mowat C, Williams C, Gillen D et al. Omeprazole, Helicobacter pylori status, and alterations in the intragastric milieu facilitating bacterial N‑ Nitrosation. Gastroenterology 2000; 119: 339– 347.
38. Robertson DJ, Larsson H, Frii S et al. Proton pump inhibitor use and risk of colorectal cancer: a population‑based, case‑ control study. Gastroenterology 2007;133: 755– 760.
39. Yang YX, Hennessy S, Propert K et al. Chronic proton pump inhibitor therapy and the risk of colorectal cancer. Gastroenterology 2007; 133: 748– 754.
40. Cats A, Schenk BE, Bloemena E et al. Parietal cell protrusions and fundic gland cysts during omeprazole maintenance treatment. Hum Pathol 2000; 31: 684– 690.
41. Jalving M, Koornstra JJ, Wesseling J et al. Increased risk of fundic gland polyps during long‑term proton pump inhibitor therapy. Aliment Pharmacol Ther 2006; 24: 1341– 1348.
42. Jalving M, Koornstra JJ, Götz JM et al. High‑grade dysplasia in sporadic fundic gland polyps: a case report and review of the literature. Eur J Gastroenterol Hepatol 2003; 15: 1229– 1233.
43. Pace F, Tonini M, Pallotta S et al. Systematic review: maintenance treatment of gastro‑oesophageal reflux disease with proton pump inhibitors taken “on‑ demand”. Aliment Pharmacol Ther 2007; 26: 195– 204.
44. Reimer C, Bytzer P. Clinical trial: long‑term use of proton pump inhibitors in primary care patients – a cross sectional analysis of 901 patients. Aliment Pharmacol Ther 2009; 30: 725– 732.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2010 Issue 2
Most read in this issue
- Central diabetes insipidus in adult patients – the first sign of Langerhans cell histiocytosis and Erdheim‑Chester disease. Three case studies and literature review
- Risk of long‑term antisecretory treatment with proton pump inhibitors
- A case study of a young male patient with subacute constrictive pericarditis
- Direct renin inhibitor aliskiren in the treatment of cardiovascular and renal diseases