ReviewLong-term Safety Concerns with Proton Pump Inhibitors
Section snippets
Pharmacology of Proton Pump Inhibitors
PPIs are substituted benzimidazole derivatives that inhibit the proton pump (H+/K+ adenosine triphosphatase) in the parietal cells of the stomach. PPIs work by accumulating in the secretory canaliculus of the acid-secreting parietal cell, where they are protonated to the active form, a cationic sulfonamide. This active form then binds to a sulfhydryl group on the proton pump and, by irreversible inhibition, prevents secretion of acid into the gastric lumen. Acid secretion resumes only after new
Overuse of Proton Pump Inhibitors
A major concern about PPIs is their potential overuse and abuse. Several studies have confirmed the overuse of these agents in both inpatient and outpatient settings. Approximately 50% to 60% of prescriptions of acid-suppressive medications in hospitalized patients are found to be without appropriate indications.4, 5, 6
Side Effects of Proton Pump Inhibitors
PPIs generally cause few adverse effects. The most common side effects are headaches, nausea, abdominal pain, constipation, flatulence, and diarrhea. These side effects are usually mild, self-limiting, and unrelated to dosage or age. However, long-term side effects of PPIs have recently gained attention, and several studies have looked at various side effects that may be associated with potential long-term use of PPI. These side effects are discussed in detail.
Conclusions
PPIs are highly effective drugs that have revolutionized the management of acid-related disorders during the last 2 decades. Although the long-term use of PPIs seems to have a high margin of safety, concerns have been raised about the potential risks after long-term use.
Although several studies have investigated the potential effect of PPI therapy on vitamin B12 absorption, a firm association cannot be established. The studies are limited by their smaller size and retrospective design.
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2019, Surgery (United States)Citation Excerpt :General complaints from PPI use may include headache, nausea, abdominal pain, constipation, or diarrhea; however, more severe chronic complaints, such as increased risk of other side effects, such as infectious diseases like pneumonia and Clostridium difficile colitis, osteoporosis, cardiac and renal failure, and dementia, have also been reported.42–48 PPI management of pathologic reflux may be hindered further by cost-effectiveness compared with operative therapy.11,42–49 We demonstrated that LARS improves patient QOL while decreasing PPI use after LARS, potentially offering financial benefits to the patient and health care system.50
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Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.
Authorship: All authors had access to the data and played a role in writing this manuscript.