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. KiaP. 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. 

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

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?

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
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.

Potential proton pump inhibitor–related adverse effects

The aim of this review is to assess the literature on PPIs with regard to common concerns, such as drug–drug interactions, the intestinal microbiome, dementia and central nervous system disease, and osteoporosis, as well as to highlight potential negative and positive impacts of the drug in cancer.

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

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

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

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.

ACG and CAG Clinical Guideline: Management of Dyspepsia

The guideline on dyspepsia is updated and patients at higher risk of malignancy (such as spending their childhood in a high risk gastric cancer country or having a positive family history) could be offered an endoscopy at a younger age.

References

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

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.

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.

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
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

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

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

Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case–control studies

Patients in hospital who received proton pump inhibitors were at increased risk of C. difficile diarrhea, and this was associated with female sex and prior renal failure.