Proton-pump inhibitors adverse effects: a review of the evidence and position statement by the Sociedad Española de Patología Digestiva

de-la-Coba, Cristóbal; Argüelles-Arias, Federico; Martín-de-Argila, C; Júdez, Javier; Linares, Antonio; Ortega‐Alonso, Aida; Rodríguez, Enrique; Rodríguez-Téllez, Manuel; Vera, Isabel; Aguilera, Lara; Álvarez, A. Carrillo; Andrade, Raúl J.; Bao, Fidencio; Castro, Manuel; Giganto, Froilán

doi:10.17235/reed.2016.4232/2016

Cited by 46 publications

(21 citation statements)

References 157 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The potential risks of long-term PPI therapy, along with the respective evidence summary, have been summarized in the Safety section. While some concerns about the possible adverse effects of PPIs (including an increased risk of gastric carcinoids, gastric carcinoma, decreased absorption of minerals and vitamins) have been raised since their introduction in the late 1980s, more recently, the number of publications dealing with PPI-related adverse outcomes has steadily increased [393–398, 417]. It is worth mentioning, however, that the majority of studies are observational in nature and do not allow for establishing causality, but merely associations [421].…”

Section: Discussionmentioning

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

344

288

View full text Add to dashboard Cite

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 ...

show abstract

Section: Discussionmentioning

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

344

288

View full text Add to dashboard Cite

show abstract

“…Both experts and national gastroenterology societies reinforce the need to review PPI dose and treatment duration in patients with risk factors for CDI, including those hospitalized or living in nursing facilities, elderly patients, immunodeficient patients, and those exposed to patients with CDI [14, 15]. …”

Section: Proposed Side Effects Of Ppismentioning

confidence: 99%

“…Despite conflicting reports in the literature, several national gastroenterology societies reinforce the need to review PPI prescription in cirrhotic patients, particularly because few conditions showed evidence of benefit with these drugs [15, 24]. …”

Section: Proposed Side Effects Of Ppismentioning

confidence: 99%

Proton Pump Inhibitors: Are They a Real Threat to the Patient?

Xavier¹,

Magalhães²,

Cotter³

2018

GE Port J Gastroenterol

View full text Add to dashboard Cite

Background: Proton pump inhibitors are among the most frequently prescribed drugs in the world and are generally considered safe. However, there is growing concern regarding their safety. Summary: A nonsystematic review of the current literature was performed regarding proton pump inhibitors and their adverse effects. Proton pump inhibitors seem to be associated with fundic gland polyp development (without clinical relevance) and Clostridium difficile infection. Also, in cirrhotic patients, their prescription should be carefully reviewed. Regarding their association with other enteric infections, micronutrient deficiency, dementia, and chronic kidney disease, current evidence is still of low quality, and further studies are needed. Key Messages: Considering the current evidence, most patients with a clear clinical indication for proton pump inhibitor treatment should probably benefit from the maintenance of their treatment without significant adverse effects. However, higher-quality studies are needed to confirm or dismiss most of the proposed adverse effects.

show abstract

“…Además, se sabe que hay factores psicológicos y sociales propios del paciente que incrementan la presión sobre el prescriptor [20] contribuyendo también al aumento del tiempo de tratamiento de manera significativa. Pese a que la prescripción inadecuada (RNM de no necesidad) de omeprazol es común a todos los niveles asistenciales, se ha estimado que aproximadamente dos tercios de las mismas proceden del ámbito hospitalario, considerándose la hospitalización como un factor de riesgo cuando se trata de dilucidar si una determinada prescripción de omeprazol lo es o no [21]. Las características de nuestro estudio no nos han permitido discriminar las prescripciones que originariamente proceden del ámbito hospitalario.…”

Section: Con Riesgo Rnm N (%)unclassified

Riesgo de resultados negativos asociados a inhibidores de la bomba de protones: revisión de las prescripciones electrónicas en pacientes polimedicados

López¹

2017

View full text Add to dashboard Cite

RESUMENIntroducción: El elevado consumo de inhibidores de la bomba de protones (IBP) puede incrementar la probabilidad de aparición de interacciones clínicamente relevantes. Pacientes mayores, polimedicados y pluripatológicos representan un grupo de alto riesgo. Se espera que la revisión sistemática de las prescripciones electrónicas (PE) permita detectar potenciales interacciones farmacológicas.Material y métodos: Estudio retrospectivo, transversal y observacional: revisión de las PE de IBP dispensadas entre enero y diciembre de 2015 en una farmacia comunitaria rural.Resultados: 1.186 PE, 164 pacientes (edad 65,7±17,2). Mayor número de pacientes en rango de edad 71-80 (n=52). Medicamentos por paciente: 11,0±5,6. PE IBP sin indicación aprobada: 27%. Indicación mayoritaria: protección frente a gastrolesión (77%). 29 pacientes (30%) con riesgo de resultados negativos asociados a la medicación (RNM) por omeprazol, 15 de ellos sin indicación. Patologías concomitantes más prevalentes: hipertensión arterial (n=81), dislipemia (n=61) y diabetes (n=36). Principios activos implicados: acenocumarol, hierro, cianocobalamina, escitalopram, benzodiazepinas y clopidogrel.Discusión: El 80% de las PE de omeprazol corresponde a pacientes entre 61 y 90 años, la mayoría con comorbilidad y polifarmacia, y supera el tiempo de tratamiento recomendado. Relacionamos la cronificación y el aumento del riesgo de RNM con la ausencia de un seguimiento adecuado.Muchos fármacos corresponsables del riesgo tratan los problemas de salud (PS) más prevalentes de nuestra población: la probabilidad de interacción resulta independiente de la correcta indicación del IBP.Conclusiones: La revisión de las PE permite valorar el riesgo de RNM y evaluar la información básica relativa al riesgo de interacción.Se detectaron RNM de no necesidad y de inseguridad en proporciones comparables. Un número elevado de PE de omeprazol tienden a cronificarse. Las interacciones más relevantes registradas ocurren a nivel metabólico. Risk of negative results associated with proton pump inhibitors: review of electronic prescription in polymedicated patients ABSTRACTIntroduction: Extensive use of proton pump inhibitors (PPI) can result in an increased risk of drug interactions. Aged polypharmacy patients are a source of particular concern. A systematic electronic prescription (EP) review allows detection of potential drug -drug interactions.Material and methods: Retrospective, transversal, observational study: review of e-prescription orders received during 2015 in our community pharmacy.Results: 1186 EP dispensed to 164 patients (age 65.7±17.2), 52 patients in 71-80 range. 11.0±5.6 medicines per patient. 27% IBP EP with no approved indication. 77% EP used as gastroprotective agent. As far as omeprazole is concerned, risk of negative outcomes associated with medication (NOM) detected in 29 patients (30%), 15 of them taking the drug without approved indication. Most prevalent comorbidities: hypertension (n=81), dyslipidemia (n=61) and diabetes (n=36). Drugs responsible for po...

show abstract

Proton-pump inhibitors adverse effects: a review of the evidence and position statement by the Sociedad Española de Patología Digestiva

Abstract: PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.

Cited by 46 publications

References 157 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: Are They a Real Threat to the Patient?

Riesgo de resultados negativos asociados a inhibidores de la bomba de protones: revisión de las prescripciones electrónicas en pacientes polimedicados

Contact Info

Product

Resources

About