Therapy: Risks associated with chronic PPI use — signal or noise?

@article{Kia2016TherapyRA,
  title={Therapy: Risks associated with chronic PPI use — signal or noise?},
  author={Leila Kia and Peter J. Kahrilas},
  journal={Nature Reviews Gastroenterology \&Hepatology},
  year={2016},
  volume={13},
  pages={253-254}
}
  • L. Kia, P. Kahrilas
  • Published 16 March 2016
  • Medicine
  • Nature Reviews Gastroenterology &Hepatology
Chronic kidney disease has joined the growing list (pneumonia, myocardial infarction, hip fracture, Clostridium difficile infections, acute interstitial nephritis, hypomagnesaemia) of putative risks associated with chronic PPI use based on results from an observational epidemiological study. However, the low hazard ratio (<1.5) makes it doubtful that this association is a causal relationship. 
View on Nature
zenodo.org
22 Citations
Background Citations
4
Results Citations
1

22 Citations

Proton pump inhibitors and risk of Clostridium difficile infection: association or causation?

TLDR
In the authors’ opinion, systematic discontinuation of PPIs in patients at risk for CDI is not warranted based on current evidence and well controlled prospective human studies are needed.

When is proton pump inhibitor use appropriate?

TLDR
While PPIs are highly efficacious in erosive acid-peptic disorders, efficacy is not equaled in other conditions and, with respect to side effects, the authors indicated that the questionable harms associated with PPI therapy do not outweigh the benefits afforded by appropriate PPI use.

Proton Pump Inhibitors in Gastroesophageal Reflux Disease: Friend or Foe

  • C. Gyawali
  • Medicine
    Current Gastroenterology Reports
  • 2017
Purpose of ReviewProton pump inhibitor (PPI) use in gastroesophageal reflux disease (GERD) has been redefined, in light of recent advances highlighting GERD phenotypes that respond to PPIs, and fresh…

Abnormal esophageal acid exposure on high‐dose proton pump inhibitor therapy is common in systemic sclerosis patients

  • E. SternD. Carlson D. Brenner
  • Medicine
    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society
  • 2018
TLDR
Reflux is characterized in SSc patients on high‐dose PPI using esophageal pH‐impedance testing and the effectiveness of PPI therapy has not been systematically studied in S sc patients.

Maintenance use of non-steroidal anti-inflammatory drugs and risk of gastrointestinal cancer in a nationwide population-based cohort study in Sweden

TLDR
Long-term use of (low-dose) aspirin and non-selective NSAIDs was associated with a decreased risk of all gastrointestinal cancer types; and lower risk if using statins.

Acid-Suppression Therapy for Gastroesophageal Reflux Disease and the Therapeutic Gap

  • L. KiaP. Kahrilas
  • Medicine
    Shackelford's Surgery of the Alimentary Tract, 2 Volume Set
  • 2019

Potential Adverse Drug Events and Nephrotoxicity Related to Prophylaxis With Omeprazole for Digestive Disorders: A Prospective Cohort Study.

Comparative Study of Spontaneous Bacterial Peritonitis in Cirrhosis Patients Managed with and without Proton Pump Inhibitors

TLDR
PPI use was significantly associated with an increased overall risk of spontaneous bacterial peritonitis and it is of core importance that PPIs should be used judiciously with regard to appropriate indications and duration in cirrhotic patients.

Emerging dilemmas in the diagnosis and management of gastroesophageal reflux disease

TLDR
Although many studies have tried to objectify the diagnosis of GERD with improved technology, this is ultimately a pragmatic diagnosis based on response to proton pump inhibitor (PPI) therapy, and, in the end, response to PPI Therapy becomes the major indication for continued PPI therapy.

Management of Gastroesophageal Reflux Disease.

TLDR
Future approaches to treatment of GERD include potassium-competitive acid blockers, reflux-reducing agents, bile acid binders, injection of inert substances into the esophagogastric junction, and electrical stimulation of the lower esophageal sphincter.

References

SHOWING 1-10 OF 13 REFERENCES

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

TLDR
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.

TLDR
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.

Proton pump inhibitors and acute kidney injury: a nested case–control study

TLDR
Renal disease was positively associated with PPI use and patients with a renal disease diagnosis were twice as likely to have used a previous prescription for a PPI, even after controlling for potential confounding conditions.

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

TLDR
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.

Long-term proton pump inhibitor therapy and risk of hip fracture.

TLDR
Long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture.

Proton Pump Inhibitors in Gastroesophageal Reflux Disease: Friend or Foe

  • C. Gyawali
  • Medicine
    Current Gastroenterology Reports
  • 2017
Purpose of ReviewProton pump inhibitor (PPI) use in gastroesophageal reflux disease (GERD) has been redefined, in light of recent advances highlighting GERD phenotypes that respond to PPIs, and fresh…

Abnormal esophageal acid exposure on high‐dose proton pump inhibitor therapy is common in systemic sclerosis patients

  • E. SternD. Carlson D. Brenner
  • Medicine
    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society
  • 2018
TLDR
Reflux is characterized in SSc patients on high‐dose PPI using esophageal pH‐impedance testing and the effectiveness of PPI therapy has not been systematically studied in S sc patients.

Low Prevalence of Hypomagnesemia in Long-term Recipients of Proton Pump Inhibitors in a Managed Care Cohort.

Risk of Community-Acquired Pneumonia with Outpatient Proton-Pump Inhibitor Therapy: A Systematic Review and Meta-Analysis

TLDR
Outpatient PPI use is associated with a 1.5-fold increased risk of CAP, with the highest risk within the first 30 days after initiation of therapy.

A nationwide nested case-control study indicates an increased risk of acute interstitial nephritis with proton pump inhibitor use

TLDR
Current use of a proton pump inhibitor was associated with a significantly increased risk of acute interstitial nephritis, relative to past use.