Search

A substantial volume of literature exists linking proton pump inhibitor (PPI) use with a multitude of serious adverse events. There is uncertainty, however, over whether these associations are clinically important. Excessive concern about PPI-related adverse events may leave patients at risk of harm by leaving acid-related upper gastrointestinal disease untreated. Conversely, the risk of treatments may outweigh the benefits if any of the purported adverse events are directly caused by PPI use; this is of particular concern where indications for PPI use are not present. In this paper, we review the studies which have reported associations between adverse events and PPI use, discuss the proposed mechanisms of action, grade the confidence in whether these associations are truly causal, and provide advice regarding balancing the benefits of PPI use against their possible harms.

The use of double-dose proton pump inhibitors (PPIs) for initial management of upper gastrointestinal (UGI) symptoms is common, though little evidence supports this practice. The aim of this study was to determine whether initial prescription of double-dose PPIs in outpatients with UGI complaints is superior to standard-dose PPIs prescription in reducing resource utilization. Patients in the Manitoba Health database prescribed double-dose PPIs were matched to individuals prescribed PPIs at standard doses. UGI-related inpatient and outpatient resource utilization and prescription drug usage were compared for both groups over the following year. Cases and controls had a similar duration of PPI use, and no difference in either UGI-related outpatient visits or UGI-related hospital admissions. Twelve-month UGI related costs were higher for double-dose PPI users. Initial therapy with double-dose PPIs does not reduce GI-related resource utilization. Prescription of double-dose PPIs as initial therapy for upper gastrointestinal symptoms should be discouraged.

Background & Aims: There are numerous gastroprotective strategies recommended for reducing the risk of upper gastrointestinal (GI) complications in long-term users of nonsteroidal anti-inflammatory drugs (NSAIDs). The relative efficacy of the different strategies alone or in combination is uncertain., Methods: We used the Manitoba Population Health Research Data Repository to perform a population-based matched case-control analysis. All NSAID users (nonselective and cyclooxygenase [COX]-2-specific) users admitted to the hospital with a primary diagnosis for an upper gastrointestinal complication were matched to NSAID-using controls in the community. We used conditional logistic regression analysis to determine the relative efficacy of different gastroprotective strategies (proton pump inhibitors [PPIs], COX-2 inhibitors, and low-dose/high-dose misoprostol) either alone or in combination and to adjust for multiple pertinent covariates., Results: A total of 1382 NSAID/COX-2 users with upper GI complications were matched to 33,957 age- and sex-matched controls. Cotherapy with PPIs or misoprostol or use of a COX-2 inhibitor all significantly reduced the risk of upper GI complications. COX-2 inhibitors were not statistically more likely to prevent upper GI complications than PPIs, although they were superior to low-dose misoprostol. The combination of COX-2 inhibitors with a PPI was associated with the greatest degree of upper GI complication risk reduction., Conclusions: All of the commonly accepted gastroprotective strategies reduce the risk of upper GI complications in NSAID users, although the combination of COX-2 inhibitors with PPIs promotes the greatest risk reduction for NSAID-related upper GI complications. Celecoxib use specifically may be superior to the combination of nonselective NSAIDs with a PPI.

Objective: To review proper use of gastroprotective strategies in family medicine for patients requiring chronic nonsteroidal anti-inflammatory drug (NSAID) therapy., Quality of Evidence: Evidence of the efficacy and safety of strategies currently in use (prostaglandin analogues, cyclooxygenase-2 inhibitors, proton pump inhibitors) is derived from randomized controlled trials (level I evidence). The simultaneous use of multiple medications for very high-risk NSAID users is supported only by expert opinion (level III evidence)., Main Message: Gastroprotective strategies should be reserved for NSAID users at substantially increased risk of gastrointestinal complications; low-risk patients can safely use NSAIDs alone. Cyclooxygenase-2 inhibitors, prostaglandin analogues, and proton pump inhibitors reduce the risk of NSAID-related gastointestinal complications by 40% to 90%. Cyclooxygenase-2 inhibitors should be avoided by patients who have or are at risk for cardiovascular disease., Conclusion: Chronic NSAID use has been implicated in the development of severe and potentially life-threatening gastointestinal complications, though certain strategies are known to decrease the risk of these NSAID-related gastointestinal complications. Prescribing physicians must know which of their patients should be prescribed medications and which strategies are appropriate for particular patients.

Background Little is known as to the extent gastrointestinal (GI) complaints are reported by women around menses. We aimed to describe GI symptoms that occurred premenstrually and during menses in healthy women, and to specifically assess the relationship of emotional symptoms to GI symptoms around menses. Methods We recruited healthy, premenopausal adult women with no indication of GI, gynecologic, or psychiatric disease who were attending an outpatient gynecology clinic for well-woman care. They completed a survey that queried menstrual histories and the presence of GI and emotional symptoms. We compared the prevalence of primary GI symptoms (abdominal pain, diarrhea, constipation, nausea, vomiting), as well as pelvic pain and bloating, in the 5 days preceding menses and during menses, and assessed whether emotional symptoms or other factors were associated with the occurrence of GI symptoms. Results Of 156 respondents, 73% experienced at least one of the primary GI symptoms either pre- or during menses, with abdominal pain (58% pre; 55% during) and diarrhea (24% pre; 28% during) being the most common. Those experiencing any emotional symptoms versus those without were more likely to report multiple (2 or more) primary GI symptoms, both premenstrually (depressed p = 0.006; anxiety p = 0.014) and during menses (depressed p < 0.001; anxiety p = 0.008). Fatigue was also very common (53% pre; 49% during), and was significantly associated with multiple GI symptoms in both menstrual cycle phases (pre p < 0.001; during p = 0.01). Conclusions Emotional symptoms occurring in conjunction with GI symptoms are common perimenstrually, and as such may reflect shared underlying processes that intersect brain, gut, and hormonal pathways. [ABSTRACT FROM AUTHOR]

The article focuses on the association between proton-pump inhibitors (PPIs) and an increased risk of hip fracture. PPIs tend to be used in preventing the complications brought about by chronic nonsteroidal anti-inflammatory drug (NSAID) therapy to the upper gastrointestinal tract. It discusses a study conducted by Douglas A. Corley and colleagues in which results prove that a long-term use of acid-inhibiting medication can lead to fracture risk. Patients using PPIs are urged to adopt practices known for limiting fracture risk, one of which is exercise.

Currently, the standard of care for high-risk peptic ulcer bleeding involves the use of a continuous intravenous proton pump inhibitor (PPI) infusion over 72 h. However, the article by Andruilli et al. details the results of a randomized controlled trial indicating that a less intensive regimen consisting of a once-daily bolus of PPI injection may lead to similar outcomes when compared to standard therapy. We will discuss these findings as well as comment on their validity, generalizability, and adaptability to clinical practice. [ABSTRACT FROM AUTHOR]