Effective and safe proton pump inhibitor therapy in acid-related diseases - A position paper addressing benefits and potential harms of acid suppression.

Authors:
Carmelo Scarpignato
Carmelo Scarpignato
University of Parma
Italy
Luigi Gatta
Luigi Gatta
University of Bologna
Italy
Angelo Zullo
Angelo Zullo
Nuovo Regina Margherita Hospital
Italy
Corrado Blandizzi
Corrado Blandizzi
University of Pisa
Italy

BMC Med 2016 11 9;14(1):179. Epub 2016 Nov 9.

Division of Pharmacology, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy.

Background: The introduction of proton pump inhibitors (PPIs) into clinical practice has revolutionized the management of acid-related diseases. Studies in primary care and emergency settings suggest that PPIs are frequently prescribed for inappropriate indications or for indications where their use offers little benefit. Inappropriate PPI use is a matter of great concern, especially in the elderly, who are often affected by multiple comorbidities and are taking multiple medications, and are thus at an increased risk of long-term PPI-related adverse outcomes as well as drug-to-drug interactions. Herein, we aim to review the current literature on PPI use and develop a position paper addressing the benefits and potential harms of acid suppression with the purpose of providing evidence-based guidelines on the appropriate use of these medications.

Methods: The topics, identified by a Scientific Committee, were assigned to experts selected by three Italian Scientific Societies, who independently performed a systematic search of the relevant literature using Medline/PubMed, Embase, and the Cochrane databases. Search outputs were distilled, paying more attention to systematic reviews and meta-analyses (where available) representing the best evidence. The draft prepared on each topic was circulated amongst all the members of the Scientific Committee. Each expert then provided her/his input to the writing, suggesting changes and the inclusion of new material and/or additional relevant references. The global recommendations were then thoroughly discussed in a specific meeting, refined with regard to both content and wording, and approved to obtain a summary of current evidence.

Results: Twenty-five years after their introduction into clinical practice, PPIs remain the mainstay of the treatment of acid-related diseases, where their use in gastroesophageal reflux disease, eosinophilic esophagitis, Helicobacter pylori infection, peptic ulcer disease and bleeding as well as, and Zollinger-Ellison syndrome is appropriate. Prevention of gastroduodenal mucosal lesions (and symptoms) in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) or antiplatelet therapies and carrying gastrointestinal risk factors also represents an appropriate indication. On the contrary, steroid use does not need any gastroprotection, unless combined with NSAID therapy. In dyspeptic patients with persisting symptoms, despite successful H. pylori eradication, short-term PPI treatment could be attempted. Finally, addition of PPIs to pancreatic enzyme replacement therapy in patients with refractory steatorrhea may be worthwhile.

Conclusions: Overall, PPIs are irreplaceable drugs in the management of acid-related diseases. However, PPI treatment, as any kind of drug therapy, is not without risk of adverse effects. The overall benefits of therapy and improvement in quality of life significantly outweigh potential harms in most patients, but those without clear clinical indication are only exposed to the risks of PPI prescription. Adhering with evidence-based guidelines represents the only rational approach to effective and safe PPI therapy. Please see related Commentary: doi: 10.1186/s12916-016-0724-1 .

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12916-016-0718-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101793PMC
November 2016
46 Reads

Article Mentions


Provided by Crossref Event Data
f1000
F1000: F1000
September 20, 2017, 8:00 pm EST

Publication Analysis

Top Keywords

acid-related diseases
16
potential harms
12
benefits potential
8
addressing benefits
8
position paper
8
paper addressing
8
scientific committee
8
harms acid
8
ppi treatment
8
management acid-related
8
evidence-based guidelines
8
acid suppression
8
clinical practice
8
proton pump
8
effective safe
8
ppi
6
therapy
6
ppis
5
her/his input
4
input writing
4

References

(Supplied by CrossRef)
Article in Dig Dis.
C Scarpignato et al.
Dig Dis. 2006
Article in Aliment Pharmacol Ther.
RH Hunt et al.
Aliment Pharmacol Ther. 2005
Article in Aliment Pharmacol Ther.
C Scarpignato et al.
Aliment Pharmacol Ther. 2006
Article in Curr Opin Pharmacol.
C Scarpignato et al.
Curr Opin Pharmacol. 2008
Article in Clin Transl Gastroenterol.
RH Hunt et al.
Clin Transl Gastroenterol. 2015
Article in Drugs.
N Vakil et al.
Drugs. 2012
Article in Am J Gastroenterol.
A Lanas et al.
Am J Gastroenterol. 2016
Article in Hépato-Gastro Oncol Digest.
JP Galmiche et al.
Hépato-Gastro Oncol Digest. 1995
Article in Soc Sci Med.
EH Boath et al.
Soc Sci Med. 1997
Article in Ther Adv Gastroenterol.
A Pottegård et al.
Ther Adv Gastroenterol. 2016
Article in Therap Adv Gastroenterol.
JJ Heidelbaugh et al.
Therap Adv Gastroenterol. 2012

Similar Publications