Complications of Proton Pump Inhibitor Therapy
Gastroenterology
A little introduction 1st
Proton Pump Inhibitor Medicines are quite often used in the treatment of GOR (Gastro-Oesophageal Reflux) or as some might simply say “Reflux”.
Proton Pump Inhibitors are medicines that suppress, that is it reduces the acid production in the stomach in response to food.
* The authors of this study evaluated the recent evidence regarding safety issues associated with proton pump inhibitors (PPIs), which have sometimes resulted in sudden discontinuation of PPI therapy. They review the suggested adverse consequences of PPI therapy and conclude that the evidence is insufficient to establish causation. Many studies are also complicated by potential confounding. The benefits of therapy should be considered in conjunction with the potential risks when making treatment decisions, and patients with an indication for PPI therapy should be treated with the lowest effective dose. Chronic therapy in patients unresponsive to initial therapy should be discouraged.
* Recent reporting regarding the safety of PPI therapy may have prevented treatment in patients with a clear indication for PPI therapy, and clinicians should cautiously analyze data while considering the benefits and harms of treatment.
The quality of evidence of harm for PPIs
There has been an accumulation of observational studies showing a growing list of potential harms from the use of proton pump inhibitors (PPIs). You can refer to this summary for data and recommendations on how to taper off a PPI.
The authors use the Hill criteria to evaluate causality vs association of PPIs off the list depicted in the graphic below.
They conclude that, “Much of the current evidence linking PPI use to serious long-term adverse consequences is weak and insubstantial. It should not deter prescribers from using appropriate doses of PPIs for appropriate indications.”
This is a broad statement that risks waiting until we have enough evidence of potential side effects to be cautious. Accumulation of evidence takes time and increases risk as we wait for high-quality studies during which harm is already occurring. The plausibility of harm for shutting off an acid pump that nature intended for all humans is high, and, as the authors state, PPIs should be used only when indicated, at the lowest dose for the shortest period of time.
At Botanica Medica our Naturopaths are well aware of the importance of a good diet and the effect it can have on your life both physically and mentally. They come across lots of interesting studies and are always updating their knowledge. If you would like to make an appointment with one of our Naturopaths call Botanica Medica on 8271-1827 today. They are only to happy to share the knowledge they have gained through their studies and patient outcomes, and get you feeling better. Botanica Medica is located at 97 Glen Osmond Road, Eastwood and appointments are available Monday to Saturday including some after hours.
Gastroenterology
Complications of Proton Pump Inhibitor Therapy
Gastroenterology 2017 Jul 01;153(1)35-48, MF Vaezi, YX Yang, CW Howden
Primary Care
Written by
David Rakel MD, FAAFP
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