Proton pump inhibitors: use and misuse in the clinical setting

Abstract

Introduction: The introduction of proton pump inhibitors (PPIs) into clinical practice has greatly improved our therapeutic approach to acid-related diseases for their efficacy and safety. Areas Covered:The following evidence-based indications for PPI use are acknowledged by many scientific societies : treatment of the various forms and A c c e p t e d M a n u s c r i p t 2 complications of gastroesophageal reflux disease, eradication of H. pylori infection in combination with two or more antibiotics, short-and long-term therapy of H. pylori-negative peptic ulcers, healing and prevention of NSAID/COXIB-associated gastric ulcers, co-therapy with endoscopic procedures to control upper digestive bleeding and medical treatment of Zollinger Ellison syndrome. Expert Commentary:Despite the above well defined indications, however, the use of PPIs continues to grow every year in both western and eastern countries and the endless expansion of PPI market has created important problems for many regulatory authorities for two relevant features : the progressive increase of the costs of therapy and the greater potential harms for the patients. The major reasons for the misuse of PPIs are the prevention of gastro-duodenal ulcers in patients without risk factors and the stress ulcer prophylaxis in nonintensive care units, steroid therapy alone, anti-platelet or anti-coagulant treatment in patients without risk of gastric injury and the overtreatment of functional dyspepsia.

Antiulcerogenic Activity of Li-Zhong Decoction on Duodenal Ulcers Induced by Indomethacin in Rats: Involvement of TLR-2/MyD88 Signaling Pathway

“…Currently, the prevention and treatment of DU mainly include clinical use of antacids, proton pump inhibitors, and H 2 receptor antagonists [24,25]. Nevertheless, long-term use of these drugs may result in undesirable side effects such as abdominal pain, nausea, sleep deprivation, diarrhea, headache, pneumonia, and osteoporosis-related fracture [26].…”

Use of Proton Pump Inhibitors in Hungary: Mixed-Method Study to Reveal Scale and Characteristics

“…In the 1990s, widespread use of proton pump inhibitors (PPIs) radically changed the treatment of acute and chronic gastroenterological diseases caused by hyperacidity (Garner et al, 1996;Savarino et al, 2018a). Different PPI products have an equivalent mechanism of action and a similar clinical efficacy (Strand et al, 2017).…”

The prevention of NSAID-induced gastric ulcers is a firmly established PPI indication

“…All these considerations, however, deal with the safety of PPIs and our recent review [7] on the use and misuse of them in the clinical setting was intended as a deep analysis of their appropriate use and frequent misuse in the clinical setting and not as a detailed appraisal of their potential adverse events and of the means to contrast them.…”