Side effects of long-term use of proton pump inhibitors: practical considerations

Castellana, Chiara; Pecere, Silvia; Furnari, Manuele; Telese, Andrea; Matteo, Maria Valeria; Haidry, Rehan; Eusebi, Leonardo Henry

doi:10.20452/pamw.15997

Cited by 10 publications

(11 citation statements)

References 87 publications

(100 reference statements)

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“…O estudo também mostrou que, além dos idosos, a hipovitaminose é frequente em vegetarianos, pacientes com hipocloridria, gastrectomia e pós cirurgia bariátrica. As consequências da diminuição dos níveis séricos de vitamina B12 estão relacionados principalmente a danos no sistema nervoso, sobretudo em casos de deficiências graves (CASTELLANA et al, 2021;MA et al, 2017).…”

Section: Revisão Bibliográficaunclassified

Efeitos adversos do uso contínuo e irracional dos Inibidores de Bomba de Prótons em idosos

Calafiori¹,

Lima²,

Silva³

et al. 2022

Braz. J. Hea. Rev.

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O presente trabalho teve por objetivo avaliar os principais efeitos adversos do uso irracional dos Inibidores da Bomba de Prótons (IBPs) na população idosa a fim de compreender as principais alterações geradas no organismo pelo uso habitual dessa classe de medicamentos. Sabe-se que, os avanços tecnológicos e em saúde propiciaram o aumento na qualidade e expectativa de vida da população ao redor do mundo, culminando na elevação exponencial de idosos. Diante disso, com o avanço da idade é comum o aparecimento de patologias, entre elas as gastrointestinais, que têm a sintomatologia tratada por IBPs. Entretanto, estudos evidenciam a relação entre o uso indevido e prolongado de IBPs e prejuízos à saúde dessa população como a ocorrência de lesão renal, hipovitaminose, riscos cardiovasculares e demências. Portanto, é necessária uma avaliação do uso desses fármacos, com o viés de serem indicados apenas com finalidade terapêutica ou profilática, ressaltando a relevância do uso por período recomendado por especialistas. Dito isso, reforça-se a importância do planejamento e da execução de ações que possibilitem o uso apropriado de IBPs, além do desenvolvimento de novas pesquisas que possibilitem a oferta de outros fármacos com o mesmo objetivo terapêutico, porém com menores efeitos adversos.

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Section: Revisão Bibliográficaunclassified

Efeitos adversos do uso contínuo e irracional dos Inibidores de Bomba de Prótons em idosos

Calafiori¹,

Lima²,

Silva³

et al. 2022

Braz. J. Hea. Rev.

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“…Guidelines suggest that after effective GORD treatment, the majority of patients do not require long-term PPI therapy, except for select indications such as severe erosive oesophagitis (Los Angeles [LA] Grade C or D) or Barrett’s oesophagus [ 19 ]. Epidemiological and experimental studies report multiple adverse effects of chronic PPI use, which differ from findings of existing RCTs [ 22 ]. Risk of adverse events is an important consideration, particularly in patients chronically taking PPIs for unspecified indications (undifferentiated abdominal pain, non-ulcer dyspepsia, functional heartburn) with limited benefit.…”

Section: Ppi Adverse Effectsmentioning

confidence: 99%

“…Decreased gastric acid production also affects nutrient absorption and gut flora, potentially leading to iron deficiency anaemia (odds ratio [OR]: 2.49), hypomagnesaemia (relative risk [RR]: 1.44), calcium, zinc, vitamin C, and B12 malabsorption (hazard ratio [HR]: 1.83), thiamine antagonism, small intestinal bacterial overgrowth (OR: 1.71), and enteric infections (OR: 4.28) [ 22 , 23 , 28–40 ]. Up to 13% of patients on PPIs long-term (mean 5.5 years) develop hypomagnesaemia (Mg < 0.7 mmol/L).…”

Section: Ppi Adverse Effectsmentioning

confidence: 99%

“…Acute interstitial nephritis in association with PPI use (RR: 3.76) has been described as an idiosyncratic reaction, which may develop into chronic kidney disease (CKD) if unrecognized or left untreated due to chronic renal interstitial scarring and tubular atrophy [ 1 , 23 , 31 ]. There are only weak associations between PPI use and development of Alzheimer’s disease (HR: 1.04) or CKD (RR: 1.32) ( Figures 1 and 2 ) [ 22 , 24 , 25 , 31 ].…”

Section: Ppi Adverse Effectsmentioning

confidence: 99%

“…This results in an ultra-rapid metabolizer phenotype and potential decreased efficacy of pantoprazole, omeprazole, or lansoprazole in treating erosive oesophagitis or gastroduodenal ulceration. Thus, polymorphisms in CYP2C19 may explain some of the variability in GORD symptom control and potential adverse side effects across differing PPI drugs and patient populations [ 22 , 32 , 39 , 41 ].…”

Section: Ppi Adverse Effectsmentioning

confidence: 99%

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Current management of gastro-oesophageal reflux disease—treatment costs, safety profile, and effectiveness: a narrative review

Lata

Trautman

Townend

et al. 2022

Gastroenterology Report

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Background The purpose of this study was to review the current management of gastro-oesophageal reflux disease (GORD), including treatment costs, safety profile and effectiveness. Methods A literature review was performed of randomized-controlled trials, systematic reviews, Cochrane reports and National/Societal guidelines of the medical, endoscopic and surgical management of GORD. Proton pump inhibitor (PPI) prescribing patterns and expenditure were reviewed in different countries, including Australia, Canada, New Zealand, UK and USA. Results Proton pump inhibitors (PPIs) are primarily indicated for control of GORD, Helicobacter pylori eradication (combined with antibiotics), preventing NSAID-induced gastrointestinal bleeding and treating peptic ulcer disease. There is widespread overprescribing of PPIs in Western and Eastern nations in terms of indication and duration, with substantial expense for national health providers. Despite a favourable short-term safety profile, there are observational associations of adverse effects with long-term PPIs. These include nutrient malabsorption, enteric infections and cardiovascular events. The prevalence of PPI use makes their long-term safety profile clinically relevant. Cost-benefit, symptom control and quality-of-life outcomes favour laparoscopic fundoplication rather than chronic PPI treatment. Laparoscopic fundoplication in long-term management of PPI-responsive GORD is supported by SAGES, NICE and ACG, and PPI-refractory GORD by AGA and SAGES guidelines. The importance of establishing a definitive diagnosis prior to invasive management is emphasized, especially in PPI-refractory heartburn. Conclusions We examined evidence-based guidelines for PPI prescribing and deprescribing in primary care and hospital settings and the need for PPI stewardship and education of health professionals. This narrative review presents the advantages and disadvantages of surgical, endoscopic and medical management of GORD, which may assist in shared decision making and treatment choice in individual patients. This paper was presented (GS020) at the 88th RACS Annual Scientific Conference, 6-10 May, 2019.

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Inappropriate proton pump inhibitor lansoprazole prescription in older adults hospitalized in long-term care unit

et al. 2022

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Purpose We evaluated the use of the PPI treatment by physicians in older adults hospitalized in a long-term care unit. Methods We included 40 patients aged 65 years or older with a lansoprazole prescription hospitalized in long-term care unit from January 2018 to January 2022. Patient characteristics, gastroduodenal history, dose of lansoprazole, indication, days of prescription, and number of medications were collected from electronic patient records. Results The mean age of patients was 84.2 ± 9.3. Patients were taking between 5 and 24 (mean = 12.7, SD = 4.4) medications overall with 15 patients taking low dose of aspirin (75 mg daily) and 8 patients taking an antiplatelet. Most patients (82.5%) received once-daily lansoprazole treatment, 55% of whom took a dose of 15 mg. Five patients were treated with the maximum dose of lansoprazole 30 mg twice daily. Only seven patients had an appropriate indication. The minimum of treatment time was 3 days and the maximum was 1198 days; moreover, 24 patients (60%) were still in treatment. Conclusion Few PPI prescriptions had an indication in the patient’s electronic record. Prescriptions were ongoing with no date of discontinuation or re-evaluation.

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Side effects of long-term use of proton pump inhibitors: practical considerations

Cited by 10 publications

References 87 publications

Efeitos adversos do uso contínuo e irracional dos Inibidores de Bomba de Prótons em idosos

Efeitos adversos do uso contínuo e irracional dos Inibidores de Bomba de Prótons em idosos

Current management of gastro-oesophageal reflux disease—treatment costs, safety profile, and effectiveness: a narrative review

Inappropriate proton pump inhibitor lansoprazole prescription in older adults hospitalized in long-term care unit

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