Novel effects other than antisecretory action and off-label use of proton pump inhibitors

Suzuki, Hidekazu; Hibi, Toshifumi

doi:10.1517/14656566.6.1.59

Cited by 20 publications

(13 citation statements)

References 43 publications

(50 reference statements)

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“…The reason for PPI responsiveness of this condition is not completely understood but could be due to other, non-antisecretory effects of PPIs [118], of which the anti-inflammatory action [119] is the most relevant one. In vitro and in vivo studies suggest that the anti-inflammatory effects of PPI therapy rather than acid suppression alone may be responsible for this improvement through inhibition of the Th2-allergic pathway [120].…”

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

346

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

346

288

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show abstract

“…We chose PPI's because they are known to be widely used off-label in high volumes of patients and patient are often sent home on a PPI based on off-label use [12]. We chose IVIG and Factor VIIa in part because they are very costly, but also because they were thought to be prescribed for a variety of off-label indications [13].…”

Section: Methodsmentioning

confidence: 99%

A trial of inpatient indication based prescribing during computerized order entry with medications commonly used off-label

Walton¹,

Galanter²,

Rosencranz

et al. 2011

Appl Clin Inform

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SummaryBackground: Requiring indications for inpatient medication orders may improve the quality of prescribing and allow for easier placement of diagnoses on the problem list. Indications for inpatient medication orders are also required by some regulators. Objective: This study assessed a clinical decision support (CDS) system designed to obtain indications and document problems during inpatient computerized physician order entry (CPOE) of medications frequently used off-label. Methods: A convenience sample of three medications frequently used off-label were selected: the PPI lansoprazole; intravenous immune globulin, and recombinant Factor VIIa. Alerts triggered when a medication was ordered without an FDA approved indication in the problem list. The alerts prompted clinicians to enter either a labeled or off-label indication for the order. Chart review was used as the gold standard to assess the accuracy of clinician entered information. Results: The PPI intervention generated 873 alerts during 60 days of operation; IVIG 55 alerts during alerts during 93 days; Factor VIIa 25 alerts during 175 days. Agreement between indications entered and chart review was 63% for PPI, 49% for IVIG, and 29% for Factor VIIa. The alerts for PPI, IVIG and Factor VIIa alerts produced accurate diagnoses for the problem list 9%, 16% and 24% respectively. Rates of off-label use measured by chart review were 87% for PPI, and 100% for IVIG and factor VIIa, which were higher than if measured using the ordering clinicians' indications. Conclusion: This trial of indication-based prescribing using CDS and CPOE produced less than optimal accuracy of the indication data as well as a low yield of accurate problems placed on the problem list. These results demonstrate the challenge inherent in obtaining accurate indication information during prescribing and should raise concerns over potential mandates for indication based prescribing and motivate further study of appropriate mechanisms to obtain indications during CPOE.

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“…The use of histamine type 2 receptor (H2R) antagonists and protonpump inhibitors (PPIs) has become widespread for the treatment of peptic ulcer disease and gastroesophageal reflux disease. 1 Although the influence of long-term acid suppression is controversial in the stomach, some reports indicated that usage of PPIs has known to be associated with the formation of gastric sporadic fundic gland polyps 2,3 and hyperplastic polyps. 4 In addition, there are reports indicating that long-term usage of H2R antagonists or PPI may facilitate the formation of gastric malignant lesions such as gastric carcinoid tumors and cancers.…”

Section: Introductionmentioning

confidence: 99%

Mucosal expression of aquaporin‐4 in the stomach of histamine type 2 receptor knockout mice and Helicobacter pylori‐infected mice

Fukuhara

Matsuzaki

Tsugawa

et al. 2014

J of Gastro and Hepatol

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Background and Aim: Basolateral water channel, aquaporin-4 (AQP4), is known to be expressed in gastric parietal cells, especially in the basal side of gastric mucosa. However, the role of AQP4 in the stomach is still unknown. Histamine type 2 receptor (H2R) knockout mice, which are characterized by suppressed gastric acid secretion, are known as formation of mucosal hyperplasia with cystic dilatation and spasmolytic polypeptideexpressing metaplasia (SPEM) in the stomach. The aim of the present study is to investigate whether the expression of AQP4 is changed by the condition of acid suppression and Helicobacter pylori infection. Methods: Male H2R knockout mice and their controls (C57BL/6) were used. H. pylori was orally infected at the age of 5 weeks. The distributions of AQP4 and H

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Novel effects other than antisecretory action and off-label use of proton pump inhibitors

Cited by 20 publications

References 43 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

A trial of inpatient indication based prescribing during computerized order entry with medications commonly used off-label

Mucosal expression of aquaporin‐4 in the stomach of histamine type 2 receptor knockout mice and Helicobacter pylori‐infected mice

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