Proton Pump Inhibitors Increase the Risk of Nonsteroidal Anti-inflammatory Drug-Related Small-Bowel Injury: A Systematic Review With Meta-analysis

Zhang, Xian; Xiao, Xue; Chen, Pingrun; Li, Yina; Lv, Xiu-He; Yang, Jin-Lin

doi:10.14309/ctg.0000000000000588

Cited by 4 publications

(2 citation statements)

References 37 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prophylactic use of omeprazole in combination with NSAIDs is often considered in practice to be a benign treatment that is more likely to be helpful than harmful ( 35 ). However, the scientific evidence does not currently support this recommendation ( 2 , 10 , 36 ) and the co-administration of PPIs with NSAIDs may in fact increase the risk of NSAID-induced intestinal injury by inducing intestinal dysbiosis in people ( 37 ) and in dogs treated with piroxicam ( 35 ). The exact mechanism for this is not well understood, but the effects of PPIs on the gastrointestinal microbiome contributing to increased cytotoxicity of bile and exacerbation of mucosal injury have been postulated ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and appropriateness of omeprazole prescription in dogs at a veterinary teaching hospital before and after the publication of the ACVIM consensus statement on the rational administration of gastrointestinal protectants

Sainz,

García-Sancho,

Villaescusa

et al. 2024

Front. Vet. Sci.

View full text Add to dashboard Cite

IntroductionOverprescribing of acid suppressants is a common phenomenon in human and small animal patients, leading to potential deleterious gastrointestinal (GI) and non-GI consequences. The impact of consensus statements on veterinary prescribing habits in clinical practice have not been fully evaluated. This study aimed to compare the prescribing habits of the proton pump inhibitor (PPI), omeprazole, in dogs in an academic veterinary teaching hospital before and after the publication of the American College of Veterinary Internal Medicine (ACVIM) consensus statement on rational use of gastrointestinal protectants.MethodsEvaluation of the prescribing habits of omeprazole in dogs during the years 2017 and 2021 was retrospectively compared. These years were selected to reflect a 12-month period prior to and following the publication of the consensus statement. One hundred dogs from each year were randomly selected. Dose, frequency of administration, duration of treatment, concurrent prescription of more than one gastroprotectant and indications for prescribing omeprazole were analyzed.ResultsA significant increase in the cases that received omeprazole q12h (p < 0.0001) or that underwent a tapering dose after ≥4 week-therapy (p > 0.0001) was detected after the publication of the 2018 ACVIM consensus statement. Considering the indications, there was also a significant increase in the appropriate prescription of omeprazole in the second compared to the first period of study (p < 0.0001). Fifteen of 16 clinicians (94%) involved in the prescription of omeprazole indicated that their reading of the consensus statement had changed their clinical practice regarding PPI administration in dogs.DiscussionThese results support the beneficial impact of the ACVIM consensus statement on the judicious prescribing of omeprazole in an academic veterinary hospital. These results should not be extrapolated to first-opinion veterinary practices, and further efforts should be made to ensure that PPIs are prescribed prudently with a clear indication and regular review of the appropriateness of continued administration to minimize possible risks and adverse drug interactions.

show abstract

Section: Discussionmentioning

confidence: 99%

Prevalence and appropriateness of omeprazole prescription in dogs at a veterinary teaching hospital before and after the publication of the ACVIM consensus statement on the rational administration of gastrointestinal protectants

Sainz,

García-Sancho,

Villaescusa

et al. 2024

Front. Vet. Sci.

View full text Add to dashboard Cite

show abstract

“…In our study, 74% of patients received PPI during hospital stay. An important finding to increase awareness among clinicians of appropriate use of PPI as a systematic review and meta-analysis showed an increased risk of small bowel damage using this medication in patients taking nonsteroidal anti-inflammatory drug (NSAID) [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Single center assessment of the role of Oakland score among patients admitted for acute lower gastrointestinal bleeding

Nieto,

Bezabih,

Narvaez

et al. 2024

BMC Gastroenterol

View full text Add to dashboard Cite

Background/Objectives The Oakland score was developed to predict safe discharge in patients who present to the emergency department with lower gastrointestinal bleeding (LGIB). In this study, we retrospectively evaluated if this score can be implemented to assess safe discharge (score ≤ 10) at WellStar Atlanta Medical Center (WAMC). Methods A retrospective cohort study of 108 patients admitted at WAMC from January 1, 2020 to December 30, 2021 was performed. Patients with LGIB based on the ICD-10 codes were included. Oakland score was calculated using 7 variables (age, sex, previous LGIB, digital rectal exam, pulse, systolic blood pressure (SBP) and hemoglobin (Hgb)) for all patients at admission and discharge from the hospital. The total score ranges from 0 to 35 and a score of ≤ 10 is a cut-off that has been shown to predict safe discharge. Hgb and SBP are the main contributors to the score, where lower values correspond to a higher Oakland score. Descriptive and multivariate analysis was performed using SPSS 23 software. Results A total of 108 patients met the inclusion criteria, 53 (49.1%) were female with racial distribution was as follows: 89 (82.4%) African Americans, 17 (15.7%) Caucasian, and 2 (1.9%) others. Colonoscopy was performed in 69.4% patients; and 61.1% patients required blood transfusion during hospitalization. Mean SBP records at admission and discharge were 129.0 (95% CI, 124.0-134.1) and 130.7 (95% CI,125.7-135.8), respectively. The majority (59.2%) of patients had baseline anemia and the mean Hgb values were 11.0 (95% CI, 10.5–11.5) g/dL at baseline prior to hospitalization, 8.8 (95% CI, 8.2–9.5) g/dL on arrival and 9.4 (95% CI, 9.0-9.7) g/dL at discharge from hospital. On admission, 100/108 (92.6%) of patients had an Oakland score of > 10 of which almost all patients (104/108 (96.2%)) continued to have persistent elevation of Oakland Score greater than 10 at discharge. Even though, the mean Oakland score improved from 21.7 (95% CI, 20.4–23.1) of the day of arrival to 20.3 (95% CI, 19.4–21.2) at discharge, only 4/108 (3.7%) of patients had an Oakland score of ≤ 10 at discharge. Despite this, only 9/108 (8.33%) required readmission for LGIB during a 1-year follow-up. We found that history of admission for previous LGIB was associated with readmission with adjusted odds ratio 4.42 (95% CI, 1.010-19.348, p = 0.048). Conclusions In this study, nearly all patients who had Oakland score of > 10 at admission continued to have a score above 10 at discharge. If the Oakland Score was used as the sole criteria for discharge most patients would not have met discharge criteria. Interestingly, most of these patients did not require readmission despite an elevated Oakland score at time of discharge, indicating the Oakland score did not really predict safe discharge. A potential confounder was the Oakland score did not consider baseline anemia during calculation. A prospective study to evaluate a modified Oakland score that considers baseline anemia could add value in this patient population.

show abstract

Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship

Dutta,

Jain,

Jearth

et al. 2023

Indian J Gastroenterol

View full text Add to dashboard Cite

Proton Pump Inhibitors Increase the Risk of Nonsteroidal Anti-inflammatory Drug-Related Small-Bowel Injury: A Systematic Review With Meta-analysis

Cited by 4 publications

References 37 publications

Prevalence and appropriateness of omeprazole prescription in dogs at a veterinary teaching hospital before and after the publication of the ACVIM consensus statement on the rational administration of gastrointestinal protectants

Prevalence and appropriateness of omeprazole prescription in dogs at a veterinary teaching hospital before and after the publication of the ACVIM consensus statement on the rational administration of gastrointestinal protectants

Single center assessment of the role of Oakland score among patients admitted for acute lower gastrointestinal bleeding

Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship

Contact Info

Product

Resources

About