Clinical Implications of Emerging Data on the Safety of Proton Pump Inhibitors

@article{SchnollSussman2017ClinicalIO,
  title={Clinical Implications of Emerging Data on the Safety of Proton Pump Inhibitors},
  author={Felice H. Schnoll-Sussman and Philip O. Katz},
  journal={Current Treatment Options in Gastroenterology},
  year={2017},
  volume={15},
  pages={1-9}
}
Opinion statementProton pump inhibitors (PPI) are among the safest class of drugs used by all care providers, including gastroenterologists. They are the mainstay in treatment of acid-related disease, in particular, gastroesophageal reflux disease. Without them, many patients would experience a major decrement in their quality of life. However, no drug is without side effects or adverse events. In the past decade, numerous reports, principally case control studies and meta-analyses, have raised… 

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References

SHOWING 1-10 OF 58 REFERENCES

Proton pump inhibitors and vascular function: A prospective cross-over pilot study

Larger, long-term and blinded trials are needed to mechanistically explain the correlation between PPI use and adverse clinical outcomes, which has recently been reported in retrospective cohort studies.

Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis.

The avoidance of PPI medication may prevent the development of dementia and is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models in which the use of PPIs increased the levels of β-amyloid in the brains of mice.

Systematic Review of the Risk of Enteric Infection in Patients Taking Acid Suppression

There is an association between acid suppression and an increased risk of enteric infection and further prospective studies on patients taking long-term acid suppression are needed to establish whether this association is causal.

Unexpected Effect of Proton Pump Inhibitors: Elevation of the Cardiovascular Risk Factor Asymmetric Dimethylarginine

This work presents a plausible biological mechanism to explain the association of PPIs with increased major adverse cardiovascular events in patients with unstable coronary syndromes and finds that PPIs elevate plasma ADMA levels and reduce nitric oxide levels and endothelium-dependent vasodilation in a murine model and ex vivo human tissues.

Proton Pump Inhibitors and Risk of Fracture: A Systematic Review and Meta-Analysis of Observational Studies

A systematic review and meta-analysis of controlled observational studies found a modest association between PPI use and increased risk of hip and vertebral fractures, but no evidence of duration effect in subgroup analysis.

Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients.

Use of drugs that inhibit gastric acid is associated with an increased risk of hip fracture; however, this association was only found among persons with at least one other risk factor for hip fracture.

Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population

The association of PPI exposure with risk for MI in the general population supports the pre-clinical findings that PPIs may adversely impact vascular function, and provides an example of how a combination of experimental and data-mining approaches can be applied to prioritize drug safety signals for further investigation.

Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease.

Proton pump inhibitor use was associated with incident CKD in unadjusted analysis and in analysis adjusted for demographic, socioeconomic, and clinical variables and future research should evaluate whether limiting PPI use reduces the incidence of CKD.

Incidence of cardiovascular events and gastrointestinal bleeding in patients receiving clopidogrel with and without proton pump inhibitors: an updated meta-analysis

The results of the meta-analysis suggest that PPIs are a marker of increased cardiovascular risk in patients taking clopidogrel, rather than a direct cause of worse outcomes, and PPIs have the potential to decrease gastrointestinal bleeding in clopIDogrel users.
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