Proton Pump Inhibitors, Associated Complications, and Alternative Therapies: A Shifting Risk Benefit Ratio

2021 ◽  
pp. 000313482199198
Author(s):  
Alexander J Friedman ◽  
Anna J Elseth ◽  
Joel R Brockmeyer
Keyword(s):  
Side Effects ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Symptom Control ◽  
Acid Reflux ◽  
Primary Therapy ◽  
Gut Dysbiosis ◽  
Increased Risk ◽  
Surgical Options

Objective Our goal was to compile the most recent and accurate data on the side effects of proton pump inhibitors (PPI). We also compared the efficacy of PPI to the efficacy of different surgical options for acid reflux control. Background Proton pump inhibitors are the primary therapy for chronic control of gastroesophageal reflux disease (GERD), but newer studies demonstrate deleterious side effects. Collating this information and contrasting it with surgical therapy for GERD provides evidence for possible practice changes in treatment. Methods A literature search utilizing PubMed was performed evaluating for PPI and anti-reflux surgery (ARS), focusing on articles that reflected information regarding the usage and efficacy of symptom control of both PPI and ARS. Search terms included “ARS, fundoplication, MSA, acute interstitial nephritis, acute kidney injury, chronic kidney disease, meta-analysis, PPI, H2 blocker, cardiovascular risk, and gut dysbiosis.” We evaluated 271 articles by title, abstract, and data for relevance and included 70. Results Long-term control of GERD with PPI may have a greater than expected side effect profile than initially thought. Surgical options may provide greater symptom control than PPI without the side effects of long-term medical therapy. Conclusions Anti-reflux control can be safely achieved with either PPI or surgical options; however, the long-term side effects noted in the review such as increased risk of cardiovascular events, renal disease, and gut dysbiosis may suggest surgical anti-reflux control as a better long-term option.

Gastroprotection during long-term NSAID use – what we know after 120 years of observations?

2021 ◽  
Vol 14 (2) ◽  
pp. 132-137
Author(s):  
Michał Lipiński
Keyword(s):  
Side Effects ◽  
Risk Stratification ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Broad Spectrum ◽  
Nsaid Therapy ◽  
Gastrointestinal Complications ◽  
Gastrointestinal Side Effects ◽  
Inflammatory Drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed classes of medications. The broad spectrum of side effects following long-term NSAID therapy includes mainly, but not only, gastrointestinal complications. Risk stratification of the gastrointestinal complications events is an important element of planning NSAIDs therapy, which allows to determine the indications for the use of proton pump inhibitors. This article presents the criteria for assessment and the method of adequate prevention of gastrointestinal side effects in patients receiving long-term NSAID therapy.

scholarly journals Long-term use of proton-pump inhibitors and risk of gastric cancer: a review of the current evidence

2019 ◽  
Vol 12 ◽  
pp. 175628481983451 ◽  
Author(s):  
Ka Shing Cheung ◽  
Wai K. Leung
Keyword(s):  
Gastric Cancer ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Randomized Clinical Trials ◽  
Bacterial Overgrowth ◽  
Current Evidence ◽  
Neoplastic Progression ◽  
Increased Risk ◽  
H Pylori

Gastric cancer remains one of the leading cancers in the world with a high mortality, particularly in East Asia. Helicobacter pylori infection accounts for the majority of the noncardia gastric cancers by triggering gastric inflammation and subsequent neoplastic progression. Eradication of H. pylori can reduce, but not totally eliminate, subsequent risk of developing gastric cancer. Proton-pump inhibitors (PPIs) are one of the most widely prescribed medications worldwide. With their profound gastric-acid suppression, there are concerns about a possible carcinogenic role in gastric cancer, due to induced hypergastrinemia, gastric atrophy and bacterial overgrowth in the stomach. While randomized clinical trials to establish causality between long-term PPI use and gastric cancer are lacking, current evidence based on observational studies suggests PPIs are associated with an increased gastric cancer risk. However, opinions on causality remain divergent due to unmeasured and possible residual confounding in various studies. Our recent study has showed that even after H. pylori eradication, long-term PPI use is still associated with an increased risk of gastric cancer by more than twofold. Hence, long-term PPIs should be used judiciously after considering individual’s risk–benefit profile, particularly among those with history of H. pylori infection. Further well-designed prospective studies are warranted to confirm the potential role of PPIs in gastric cancer according to baseline gastric histology and its interaction with other chemopreventive agents like aspirin, statins and metformin.

Proton Pump Inhibitors and Dabigatran Therapy: Impact on Gastric Bleeding and Dabigatran Plasma Levels

2019 ◽  
Vol 45 (08) ◽  
pp. 846-850 ◽  
Author(s):  
Tomáš Bolek ◽  
Matej Samoš ◽  
Ingrid Škorňová ◽  
Peter Galajda ◽  
Ján Staško ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Plasma Levels ◽  
Thrombin Inhibitor ◽  
Gi Bleeding ◽  
Gastric Bleeding ◽  
Increased Risk ◽  
The Impact ◽  
Dabigatran Therapy

AbstractDabigatran etexilate, a direct thrombin inhibitor, is now frequently used for long-term pharmacological prevention of stroke or systemic embolism in patients with atrial fibrillation. However, such long-term dabigatran therapy (DT) significantly increases the risk of upper gastrointestinal (GI) bleeding. This increased risk of gastric bleeds might be reduced with gastroprotective agents, such as proton pump inhibitors (PPIs). PPIs coadministrated with dabigatran reduce the risk of upper GI bleeding in patients on long-term oral DT. Nevertheless, there is heated discussion regarding interactions between PPI and dabigatran that lead to decreases in dabigatran plasma levels. This article reviews up to date data about the risk of gastric bleeding on dabigatran, the impact of PPI on the reduction of gastric bleeding, and the interaction between PPI and dabigatran leading to decreased dabigatran plasma levels.

Proton pump inhibitors and upper gastrointestinal cancers

2019 ◽  
Vol 12 (9) ◽  
pp. 526-530
Author(s):  
Monica Kumar
Keyword(s):  
Gastric Cancer ◽  
General Practice ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Cost Effective ◽  
Gastrointestinal Cancers ◽  
Increased Risk ◽  
The Uk ◽  
Upper Gastrointestinal

Proton pump inhibitors (PPIs) were introduced in the 1980s. They are now one of the most commonly prescribed drugs in general practice. They are cost-effective when used correctly; however, PPIs are often used beyond accepted clinical indications. Recent published studies performed outside the UK have suggested that adverse effects are associated with long-term use of PPIs; in particular, an increased risk of gastric cancer. This article will aim to systematically assess the evidence and discuss its application to our clinical practice.

scholarly journals Long Term Use of Proton Pump Inhibitors: Where to Draw the Line

2018 ◽  
Vol 1 (1) ◽  
pp. 20-35
Author(s):  
M. Manzurul Haque
Keyword(s):  
Adverse Effects ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Community Acquired Pneumonia ◽  
Ulcer Disease ◽  
Increased Risk ◽  
Prospective Trials ◽  
Evidence Based Therapy ◽  
Clostridium Difficile Associated Diarrhea

Proton pump inhibitors are the leading evidence-based therapy for acid related upper gastrointestinal disorders including dyspepsia, GERD and peptic ulcer disease. These are among the most frequently prescribed drugs globally. However, PPIs have been subjected to studies and have been associated with increased risk of adverse effects like Clostridium difficile-associated diarrhea, community-acquired pneumonia, bone fracture, reduced intestinal absorption of vitamins and minerals, and more recently kidney damage and dementia etc. In this review the recent literature regarding these adverse effects and their association with long-term proton pump inhibitor treatment is discussed. The objective of this review is to analyse the potential adverse effects of long-term PPI use and summarize the clinical implications. We documented a considerable increase in the use of PPIs over the last decade. This increase is due to over-prescription and use of PPIs for inappropriate indications. On the other hand, some patients may have had PPI therapy discontinued abruptly or inappropriately due to safety concerns. However the patients with a proven indication for a PPI should continue to receive it in the lowest effective dose for a shortest possible time. Finally, in most cases and based on the available evidence, PPIs benefits seem to outweigh potential adverse effects. Large randomized prospective trials are required to more firmly establish direct cause and effect relationships between PPIs and adverse events.

scholarly journals Possible Effects of Proton Pump Inhibitors on Hearing Loss Development

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Michał Wiciński ◽  
Bartosz Malinowski ◽  
Oskar Puk ◽  
Karol Górski ◽  
Dawid Adamkiewicz ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Side Effects ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Life Quality ◽  
Circulatory System ◽  
Whole Body ◽  
Over The Counter ◽  
The Impact

For their being considered safe and as over-the-counter (OTC) drugs, proton pump inhibitors (PPI) are one of the most frequently used medicines nowadays. However, for the last couple of years, many researches analyzing PPI were conducted and these studies shed light on PPI side effects and mechanisms of these processes. Particularly, interesting is the impact of PPI on hearing loss development. However, this side effect seems to be local and its mechanisms are complex and systemic and involve changes in the whole body. This paper summarizes how through, inter alia, alterations in circulatory system, respiratory system, central nervous system, and metabolic changes PPI can cause hearing impairment, which can occur at every age and is connected with long-term use of this group of drugs. Another important finding is the role of PPI in acceleration of presbycusis development which is disturbing with regard to the fact that elders are the group who most frequently use PPI in the long term. Hearing loss is the factor which gravely decreases life quality, especially among elders who are the most afflicted group; thus, administration of PPI should be considered carefully, taking under consideration all benefits and all potential side effects.

scholarly journals Proton Pump Inhibitors Accelerate Endothelial Senescence

2016 ◽  
Vol 118 (12) ◽  
Author(s):  
Gautham Yepuri ◽  
Roman Sukhovershin ◽  
Timo Z. Nazari-Shafti ◽  
Michael Petrascheck ◽  
Yohannes T. Ghebre ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Chronic Exposure ◽  
Vascular Dysfunction ◽  
Term Effect ◽  
Long Term Effect ◽  
Increased Risk ◽  
Neurological Morbidity

Rationale: Proton pump inhibitors (PPIs) are popular drugs for gastroesophageal reflux, which are now available for long-term use without medical supervision. Recent reports suggest that PPI use is associated with cardiovascular, renal, and neurological morbidity. Objective: To study the long-term effect of PPIs on endothelial dysfunction and senescence and investigate the mechanism involved in PPI-induced vascular dysfunction. Methods and Results: Chronic exposure to PPIs impaired endothelial function and accelerated human endothelial senescence by reducing telomere length. Conclusions: Our data may provide a unifying mechanism for the association of PPI use with increased risk of cardiovascular, renal, and neurological morbidity and mortality.

scholarly journals Proton Pump Inhibitors and Fractures in Adults: A Critical Appraisal and Review of the Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-15
Author(s):  
Silvia Irina Briganti ◽  
Anda Mihaela Naciu ◽  
Gaia Tabacco ◽  
Roberto Cesareo ◽  
Nicola Napoli ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Bone Health ◽  
Meta Analysis ◽  
Fragility Fractures ◽  
High Dose ◽  
Case Control Studies ◽  
Number Of Patients ◽  
Increased Risk

Despite the large number of patients worldwide being on proton pump inhibitors (PPIs) for acid-related gastrointestinal disorders, uncertainty remains over their long-term safety. Particularly, the potential side effects of these drugs on bone health have been evaluated in the last years. The purpose of our narrative review is to gather and discuss results of clinical studies focusing on the interactions between PPIs and fracture risk. Data generated mainly from nested case-control studies and meta-analysis suggest that long-term/high-dose PPIs users are characterized by an increased risk of fragility fractures, mainly hip fractures. However, in these studies, the PPIs-induced bone impairment is often not adjusted for different confounding variables that could potentially affect bone health, and exposure to PPIs was reported using medical prescriptions without adherence evaluation. The mechanisms of the PPI-related bone damage are still unclear, but impaired micronutrients absorption, hypergastrinemia, and increased secretion of histamine may play a role. Clinicians should pay attention when prescribing PPIs to subjects with a preexistent high risk of fractures and consider antiosteoporotic drugs to manage this additive effect on the bone. However, further studies are needed to clarify PPIs action on the bone.

Fatal Spontaneous Clostridium septicum Gas Gangrene: A Possible Association With Iatrogenic Gastric Acid Suppression

2014 ◽  
Vol 138 (6) ◽  
pp. 837-841 ◽  
Author(s):  
Yiru E. Wu ◽  
Alexander Baras ◽  
Toby Cornish ◽  
Stefan Riedel ◽  
Elizabeth C. Burton
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Proton Pump Inhibitor Therapy ◽  
Gas Gangrene ◽  
Acid Suppression ◽  
Clostridium Septicum ◽  
Increased Risk ◽  
Intestinal Ulcers ◽  
Gastric Acid Suppression

The long-term use of proton pump inhibitors has been linked to an increased risk for the development of gastric polyps, hip fractures, pneumonia, and Clostridium difficile colitis. There is evidence that chronic acid suppression from long-term use of proton pump inhibitors poses some risk for the development of C difficile–associated diarrhea by decreasing the elimination of pathogenic microbes before reaching the lower gastrointestinal tract. Here we present a case of a 51-year-old woman with a recent history of abdominal pain and fever who presented to the emergency department with rapidly progressive spontaneous necrotizing fasciitis and gas gangrene and died within hours of presentation. Postmortem examination confirmed spreading tissue gas gangrene and myonecrosis. In addition, multiple intestinal ulcers containing Clostridium septicum were present at autopsy. This case illustrates a possible association between proton pump inhibitor therapy and fatal C septicum infection.

scholarly journals Side effects of long-term use of proton pump inhibitors: practical considerations

2021 ◽  
Author(s):  
Chiara Castellana ◽  
Silvia Pecere ◽  
Manuele Furnari ◽  
Andrea Telese ◽  
Maria Valeria Matteo ◽  
...  
Keyword(s):  
Side Effects ◽  
Proton Pump Inhibitors ◽  
Proton Pump
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