The Inappropriate Prescription of Oral Proton Pump Inhibitors in the Hospital Setting: A Prospective Cross-Sectional Study

Kelly, Orlaith; Dillane, Catherine; Patchett, Stephen; Harewood, Gavin C.; Murray, Frank E.

doi:10.1007/s10620-015-3642-8

Cited by 71 publications

(48 citation statements)

References 14 publications

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“…Recently, Kelly et al underlined how inappropriate PPI therapy is still a problem in hospitals, though it appears to be at a lower level compared with previous studies. 16,17 The present study clearly demonstrated that in over 100 years subjects the gastric acid production is preserved in 80% of the studied population. This results is quite difBref report Table 1 fering from that previously thought, and why this occurs is unknown.…”

Section: Discussionsupporting

confidence: 65%

Non-invasive assessment of gastric secretory function in centenarians

Tursi¹,

Bastiani²,

Franceschi³

et al. 2017

Geriatr Care

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Gastric acid secretion is believed to decrease in the aging stomach, but the number of elderly patients on proton pump inhibitor (PPI) therapy is increasing.The aim was to assess gastric function by means of serology (PGI, PGII, G17 and IgG antibodies against Helicobacter pylori) in centenarians.Twenty-five centenarians (2 males, 23 females, mean age 101.3 years, range 100-106 years) underwent to serological gastric markers assessment by means of Gastropanel ® . Patients with laboratory signs of severe oxyntic gastric atrophy (OGA) underwent gastroscopy with biopsy samples.Twelve patients (48.0%) had serological values according to normal gastric secretion; 3 patients (12%) had serological values according to severe OGA, confirmed by histology; 21 patients (84.0%) had serological values according to H. pylori infection.Acid secretion seems to be preserved in a large part of centenarians. Serological markers may be helpful to identify patients affected by OGA, in whom the administration of PPI is inappropriate.

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Section: Discussionsupporting

confidence: 65%

Non-invasive assessment of gastric secretory function in centenarians

Tursi¹,

Bastiani²,

Franceschi³

et al. 2017

Geriatr Care

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“…The clinical signs and symptoms of dementia are insidious, leading to a high prevalence of missed and delayed diagnoses. 32 Moreover, 25–50% of PPI prescriptions in ambulatory and in-patient settings lack appropriate indications 33–35 and non-judicious PPI prescribing is especially frequent among the elderly and those with cognitive impairment. 36 Therefore, elderly individuals who have frequent contact with health providers are at increased risk of both PPI prescription and dementia diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Association Between Proton Pump Inhibitor Use and Cognitive Function in Women

et al. 2017

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Background & Aims Studies have reported associations between proton pump inhibitor (PPI) use and dementia. However, data are lacking on long-term PPI use and cognitive function. We therefore examined associations between PPI use and performance in tests of cognitive function. Because of shared clinical indications, we examined associations for H2 receptor antagonists (H2RAs) as a secondary aim. Methods We used prospectively collected data on medication use and other potential risk factors from 13,864 participants in the Nurses’ Health Study II who had completed a self-administered computerized neuropsychological test battery. Multi-variable linear regression models were used to examine associations between medication use and composite scores of psychomotor speed and attention, learning and working memory, and overall cognition. Results We observed a modest association between duration of PPI use and scores for psychomotor speed and attention (mean score difference for PPI use of 9–14 yrs vs never users, −0.06; 95% CI, −0.11 to 0.00; Ptrend = .03). After controlling for H2RA use, the magnitude of this score difference was attenuated. Among individuals who did not regularly use PPIs, duration of H2RA use was associated with poorer cognitive scores, with the strongest association apparent for learning and working memory (mean score difference for H2RA users of 9–14 years vs never users, −0.20; 95% CI, −0.32 to −0.08; Ptrend < .001). Conclusions In an analysis of data from the Nurses’ Health Study II, we did not observe a convincing association between PPI use and cognitive function. Our data do not support the suggestion that PPI use increases dementia risk. Since our primary hypothesis related to PPI use, our findings for H2RAs should be interpreted with caution.

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“…However, especially in patients with functional dyspepsia, which is defined as the presence of symptoms with no evidence of pathologically based gastroduodenal disorders (i.e., GERD, hiatal hernia, peptic ulcer) (17), the efficacy of PPIs appears to be limited (18,19). Nevertheless, there is growing perception of indiscriminate use of PPIs worldwide (20), which would arise from either medical hyperprescription (21,22) or self-diagnosis and treatment due to the over-the-counter availability of these medications (23).…”

mentioning

confidence: 99%

Effects of Proton Pump Inhibitors on the Gastric Mucosa-Associated Microbiota in Dyspeptic Patients

Sterbini

Palladini

Masucci

et al. 2016

Appl Environ Microbiol

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Besides being part of anti-Helicobacter pylori treatment regimens, proton pump inhibitors (PPIs) are increasingly being used to treat dyspepsia. However, little is known about the effects of PPIs on the human gastric microbiota, especially those related to H. pylori infection. The goal of this study was to characterize the stomach microbial communities in patients with dyspepsia and to investigate their relationships with PPI use and H. pylori status. Using 16S rRNA gene pyrosequencing, we analyzed the mucosa-associated microbial populations of 24 patients, of whom 12 were treated with the PPI omeprazole and 9 (5 treated and 4 untreated) were positive for H. pylori infection. The Proteobacteria, Firmicutes, Bacteroidetes, Fusobacteria, and Actinobacteria phyla accounted for 98% of all of the sequences, with Helicobacter, Streptococcus, and Prevotella ranking among the 10 most abundant genera. H. pylori infection or PPI treatment did not significantly influence gastric microbial species composition in dyspeptic patients. Principal-coordinate analysis of weighted UniFrac distances in these communities revealed clear but significant separation according to H. pylori status only. However, in PPI-treated patients, Firmicutes, particularly Streptococcaceae, were significantly increased in relative abundance compared to those in untreated patients. Consistently, Streptococcus was also found to significantly increase in relation to PPI treatment, and this increase seemed to occur independently of H. pylori infection. Our results suggest that Streptococcus may be a key indicator of PPI-induced gastric microbial composition changes in dyspeptic patients. Whether the gastric microbiota alteration contributes to dyspepsia needs further investigation. IMPORTANCEAlthough PPIs have become a popular treatment choice, a growing number of dyspeptic patients may be treated unnecessarily. We found that patients treated with omeprazole showed gastric microbial communities that were different from those of untreated patients. These differences regarded the abundances of specific taxa. By understanding the relationships between PPIs and members of the gastric microbiota, it will be possible to envisage new strategies for better managing patients with dyspepsia.

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The Inappropriate Prescription of Oral Proton Pump Inhibitors in the Hospital Setting: A Prospective Cross-Sectional Study

Abstract: Inappropriate PPI therapy is still a problem in hospitals, though it appears to be at a lower level compared with previous studies. Awareness of evidence-based guidelines and targeted medicine reconciliation strategies are essential for cost-effective and safe use of these medications.

Cited by 71 publications

References 14 publications

Non-invasive assessment of gastric secretory function in centenarians

Non-invasive assessment of gastric secretory function in centenarians

Association Between Proton Pump Inhibitor Use and Cognitive Function in Women

Effects of Proton Pump Inhibitors on the Gastric Mucosa-Associated Microbiota in Dyspeptic Patients

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