Effects of proton pump inhibitor on outcomes of patients with severe acute pancreatitis based on a national administrative database

Murata, Atsuhiko; Ohtani, Makoto; Muramatsu, Keiji; Matsuda, Shinya

doi:10.1016/j.pan.2015.07.006

Cited by 15 publications

(12 citation statements)

References 28 publications

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“…The only clinical trial to date [368] found that treatment with pantoprazole does not affect the clinical course of AP such as the length of hospitalization, time to starting oral intake or pain relief. In addition, two retrospective studies found that PPI use does not affect clinical outcomes of patients with severe AP [369] or prevent post- endoscopic retrograde cholangiopancreatography pancreatitis [370]. As a consequence, most international guidelines on the management of AP do not even mention PPIs.…”

Section: Resultsmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

351

288

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BackgroundThe introduction of proton pump inhibitors (PPIs) into clinical practice has revolutionized the management of acid-related diseases. Studies in primary care and emergency settings suggest that PPIs are frequently prescribed for inappropriate indications or for indications where their use offers little benefit. Inappropriate PPI use is a matter of great concern, especially in the elderly, who are often affected by multiple comorbidities and are taking multiple medications, and are thus at an increased risk of long-term PPI-related adverse outcomes as well as drug-to-drug interactions. Herein, we aim to review the current literature on PPI use and develop a position paper addressing the benefits and potential harms of acid suppression with the purpose of providing evidence-based guidelines on the appropriate use of these medications.MethodsThe topics, identified by a Scientific Committee, were assigned to experts selected by three Italian Scientific Societies, who independently performed a systematic search of the relevant literature using Medline/PubMed, Embase, and the Cochrane databases. Search outputs were distilled, paying more attention to systematic reviews and meta-analyses (where available) representing the best evidence. The draft prepared on each topic was circulated amongst all the members of the Scientific Committee. Each expert then provided her/his input to the writing, suggesting changes and the inclusion of new material and/or additional relevant references. The global recommendations were then thoroughly discussed in a specific meeting, refined with regard to both content and wording, and approved to obtain a summary of current evidence.ResultsTwenty-five years after their introduction into clinical practice, PPIs remain the mainstay of the treatment of acid-related diseases, where their use in gastroesophageal reflux disease, eosinophilic esophagitis, Helicobacter pylori infection, peptic ulcer disease and bleeding as well as, and Zollinger–Ellison syndrome is appropriate. Prevention of gastroduodenal mucosal lesions (and symptoms) in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) or antiplatelet therapies and carrying gastrointestinal risk factors also represents an appropriate indication. On the contrary, steroid use does not need any gastroprotection, unless combined with NSAID therapy. In dyspeptic patients with persisting symptoms, despite successful H. pylori eradication, short-term PPI treatment could be attempted. Finally, addition of PPIs to pancreatic enzyme replacement therapy in patients with refractory steatorrhea may be worthwhile.ConclusionsOverall, PPIs are irreplaceable drugs in the management of acid-related diseases. However, PPI treatment, as any kind of drug therapy, is not without risk of adverse effects. The overall benefits of therapy and improvement in quality of life significantly outweigh potential harms in most patients, but those without clear clinical indication are only exposed to the risks of PPI prescription. Adhering with evidence-based ...

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Section: Resultsmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

351

288

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“…PPIs use was defined as receiving intravenous omeprazole, pantoprazole, or/and esomeprazole at least once during hospitalization ( Murata et al, 2015 ). Etiology was divided into four types ( Wang et al, 2009 ).…”

Section: Methodsmentioning

confidence: 99%

“…In a previous case report, lansoprazole has been used successfully to treat and prevent recurrent AP that was induced by chemotherapy in children with acute lymphoblastic leukemia/lymphoma ( Fettah et al, 2014 ). By contrast, a retrospective study conducted in Japan using the national administrative database revealed that the use of PPIs did not reduce the mortality in patients with severe acute pancreatitis ( Murata et al, 2015 ), in which data of other outcomes, including local complications and the length of hospital stay, and were not reported. At present, to the best of our knowledge, there has only been one prospective study that demonstrated that pantoprazole did not alter the clinical course of AP ( Yoo et al, 2012 ), although a limited sample size (40 in total), and the heterogeneity among the enrolled patients render these results ambiguous ( Yoo et al, 2012 ).…”

Section: Introductionmentioning

confidence: 94%

“…Despite the lack of conclusive evidence, proton pump inhibitors (PPIs) have been empirically used as the standard therapeutic method for AP in many countries worldwide, including Japan, Korea, China, Italy, and those in Eastern Europe ( Pezzilli et al, 2007 ; Hajjar et al, 2012 ; Xia et al, 2012 ; Yoo et al, 2012 ; Gorsky et al, 2015 ; Murata et al, 2015 ). PPIs act by effectively reducing the quantity of intraluminal acid in the stomach and duodenum, mechanistically by blocking the common terminal pathway for acid secretion, which lies at the H + -K + -adenosine triphosphatase (ATPase) ( Robinson, 2004 ).…”

Section: Introductionmentioning

confidence: 99%

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Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

et al. 2021

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Background: Acute pancreatitis (AP) is a systemic inflammatory disorder with a wide spectrum of clinical symptoms that can range from mild to severe. Previous preclinical study results suggest that proton pump inhibitors (PPIs) can inhibit exocrine pancreatic secretion and exert anti-inflammatory properties, which might in turn improve the outcome of AP.Aim: We conducted this multicenter, retrospective cohort study to investigate the potential effects of PPIs on the mortality, and total duration of hospital stay and local complication occurrence of patients with AP.Methods: A total of 858 patients with AP were included. All patients presented to the hospital within 48 h of symptom onset and were divided into the following two groups: patients who were treated with PPIs (n = 684) and those not treated with PPIs (n = 174). We used propensity score matching (PSM) analysis to reduce confounding bias before comparing the outcomes between the two groups.Results: Before PSM analysis, there were significant differences in a number of parameters between the two groups, including age, sex, hematocrit, blood urea nitrogen, peritonitis signs, Ranson’s score, and Acute Physiology Chronic Health Evaluation II score and organ failure occurrence. Before PSM, the PPIs group had a higher rate of mortality than the control group [RR = 1.065; 95% confidence ratio (CI) 1.045–1.086; p = 0.001]. After PSM, there was no significant difference in mortality (RR = 1.009; 95% CI, 0.999–1.019; p = 0.554) or total hospital stay (p = 0.856), although the PPIs group had a lower occurrence of pancreatic pseudocyst (RR = 0.416; 95% CI 0.221–0.780; p = 0.005).Conclusion: This study showed that PPIs therapy was not associated with reduced mortality or total hospital stay, but was associated with a reduction in the occurrence of pseudocysts in patients with acute pancreatitis.

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“…PPIs are recommended for AP treatment in Chinese guidelines in 2019 3 . The data from a Japanese national administrative database showed that PPIs were used in approximately 37.3% (3879/10,400 cases) of SAP patients 4 . A similar situation also exists in Korea 5 .…”

mentioning

confidence: 99%

The impacts of acid suppression on duodenal microbiota during the early phase of severe acute pancreatitis

Huang

et al. 2020

Sci Rep

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Duodenal dysbiosis may be potential infection risks in patients with severe acute pancreatitis (SAP). Acid-suppression drugs (ACDs) are widely used in SAP patients in Asian countries. However, the impact of ACDs on duodenal microbiota during the early phase of SAP is still unknown. This randomized controlled clinical trial evaluated the impacts of esomeprazole (Eso), one of ACDs on duodenal microbiota during the first week of SAP with duodenal aspirates culture and 16sRNA Illumina sequencing analysis. 66 patients were randomized as 1:1 ratio into Eso group (Eso 40 mg/day) and Eso-N group (no Eso). The occurrence of duodenal bacterial overgrowth (DBO) was significantly higher in Eso group (about 85%) than that in Eso-N group (about 42%). The duodenal microbiota of the SAP patients shifted away from that of the normal control. There were differences between the Eso-N and Eso groups including enriched abundances of the class Negativicutes, order Selenomonadales and genus Veillonella. Acid suppression significantly increased incidence of Candida oesophagitis (CE) by 8-folds but did not increase other infectious events. In conclusion, acid suppression greatly increased the occurrence of DBO, duodenal dysbiosis and CE during the first week of SAP. Restrictive use of acid-suppressing medications might be helpful to reduce CE and potential risk of pancreatic infection in SAP patients.Trial registration: Chictr.org, ChiCTR-IPR-16008301, Registered April 18 2016, http://www.chictr.org.cn/showproj.aspx?proj=14089.

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Effects of proton pump inhibitor on outcomes of patients with severe acute pancreatitis based on a national administrative database

Cited by 15 publications

References 28 publications

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

The impacts of acid suppression on duodenal microbiota during the early phase of severe acute pancreatitis

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