Cristóbal de la Coba Ortiz1, Federico Argüelles Arias2, Carlos Martín de Argila de Prados3, Javier Júdez Gutiérrez4, Antonio Linares Rodríguez5, Aida Ortega Alonso6, Enrique Rodríguez de Santiago3, Manuel Rodríguez-Téllez7, María Isabel Vera Mendoza8, Lara Aguilera Castro9, Ángel Álvarez Sánchez10, Raúl Jesús Andrade Bellido11, Fidencio Bao Pérez12, Manuel Castro Fernández13, Froilán Giganto Tomé14. 1. Sección de Aparato Digestivo. , Hospital de Cabueñes, España. 2. UGC Aparato Digestivo, H. Universitario Virgen Macarena, España. 3. Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, España. 4. Departamento de Gestión del Conocimiento, Sociedad Española de Patología Digestiva SEPD, España. 5. Servicio Aparato Digestivo, Sanatorio Nuestra Señora de Covadonga, España. 6. UGC Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, España. 7. UGC Intercentros de Aparato Digestivo , Hospital Universitario Virgen de la Macarena (HUVM), España. 8. Servicio Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, ESPAÑA. 9. Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal. , España. 10. Servicio de Aparato Digestivo, Hospital Clínico San Carlos. Universidad Complutense de Madrid., España. 11. Unidad de Gestión Clinica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, España. 12. Sección Aparato Digestivo, Hospital San Eloy, España. 13. Servicio de Aparato Digestivo, Hospital Universitario de Valme, España. 14. Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, España.
Abstract
INTRODUCTION: In the last few years a significant number of papers have related the use of proton-pump inhibitors (PPIs) to potential serious adverse effects that have resulted in social unrest. OBJECTIVE: The goal of this paper was to provide a literature review for the development of an institutional position statement by Sociedad Española de Patología Digestiva (SEPD) regarding the safety of long-term PPI use. MATERIAL AND METHODS: A comprehensive review of the literature was performed to draw conclusions based on a critical assessment of the following: a) current PPI indications; b) vitamin B12 deficiency and neurological disorders; c) magnesium deficiency; d) bone fractures; e) enteric infection and pneumonia; f) interactions with thienopyridine derivatives; e) complications in cirrhotic patients. RESULTS: Current PPI indications have remained unchanged for years now, and are well established. A general screening of vitamin B12 levels is not recommended for all patients on a PPI; however, it does seem necessary that magnesium levels be measured at therapy onset, and then monitored in subjects on other drugs that may induce hypomagnesemia. A higher risk for bone fractures is present, even though causality cannot be concluded for this association. The association between PPIs and infection with Clostridium difficile is mild to moderate, and the risk for pneumonia is low. In patients with cardiovascular risk receiving thienopyridines derivatives it is prudent to adequately consider gastrointestinal and cardiovascular risks, given the absence of definitive evidence regardin potential drug-drug interactions; if gastrointestinal risk is found to be moderate or high, effective prevention should be in place with a PPI. PPIs should be cautiously indicated in patients with decompensated cirrhosis. CONCLUSIONS: PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.
INTRODUCTION: In the last few years a significant number of papers have related the use of proton-pump inhibitors (PPIs) to potential serious adverse effects that have resulted in social unrest. OBJECTIVE: The goal of this paper was to provide a literature review for the development of an institutional position statement by Sociedad Española de Patología Digestiva (SEPD) regarding the safety of long-term PPI use. MATERIAL AND METHODS: A comprehensive review of the literature was performed to draw conclusions based on a critical assessment of the following: a) current PPI indications; b) vitamin B12deficiency and neurological disorders; c) magnesiumdeficiency; d) bone fractures; e) enteric infection and pneumonia; f) interactions with thienopyridine derivatives; e) complications in cirrhotic patients. RESULTS: Current PPI indications have remained unchanged for years now, and are well established. A general screening of vitamin B12 levels is not recommended for all patients on a PPI; however, it does seem necessary that magnesium levels be measured at therapy onset, and then monitored in subjects on other drugs that may induce hypomagnesemia. A higher risk for bone fractures is present, even though causality cannot be concluded for this association. The association between PPIs and infection with Clostridium difficile is mild to moderate, and the risk for pneumonia is low. In patients with cardiovascular risk receiving thienopyridines derivatives it is prudent to adequately consider gastrointestinal and cardiovascular risks, given the absence of definitive evidence regardin potential drug-drug interactions; if gastrointestinal risk is found to be moderate or high, effective prevention should be in place with a PPI. PPIs should be cautiously indicated in patients with decompensated cirrhosis. CONCLUSIONS: PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.
Authors: Michał Wiciński; Bartosz Malinowski; Oskar Puk; Karol Górski; Dawid Adamkiewicz; Grzegorz Chojnacki; Maciej Walczak; Eryk Wódkiewicz; Monika Szambelan; Paulina Adamska; Kamila Skibińska; Maciej Socha; Maciej Słupski; Katarzyna Pawlak-Osińska Journal: Biomed Res Int Date: 2019-10-17 Impact factor: 3.411