Abstract
Proton-pump inhibitors (PPIs) are commonly utilized in the treatment of upper gastrointestinal bleeds (UGIBs) due to their ability to stabilize blood clot formation. PPIs have been shown to reduce rebleeding after endoscopic hemostasis and reduce signs of bleeding at index endoscopy. While PPIs are well-tolerated and commonly administered to patients suffering from acute UGIBs, significant adverse effects may occur. Patients have reported various mild systemic symptoms during short-term PPI use, including headache, rash, dizziness, nausea, abdominal pain, flatulence, constipation, and diarrhea. In general, serious side effects of PPIs tend to be mild during treatment periods under two weeks; however, as the treatment duration increases, side effects have been observed to increase in frequency and severity. PPI-induced thrombocytopenia is an exceedingly rarely reported adverse reaction that remains largely unstudied due to the dearth of patient cases. This adverse effect continues to be a diagnosis of exclusion, and there are no current evidence-based recommendations to approach this complication. Thrombocytopenia increases the risk of rebleeding and hemodynamic instability, which may be devastating to patients suffering from UGIBs. Here, we present a case of thrombocytopenia that began after the introduction of pantoprazole in the setting of a UGIB. The thrombocytopenia resolved promptly after cessation of the medication. We highlight this case to increase awareness of this rare finding given the lack of recommendations for short-term PPI-induced thrombocytopenia.
Highlights
Proton-pump inhibitors (PPIs) are a class of drugs that are widely used for the treatment of a variety of gastric acid-related disorders, including peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) [1]
Findings in the current literature and our observations suggest that PPIs may cause thrombocytopenia
The current literature only has several case studies listing pantoprazole as a cause of drug-induced thrombocytopenia, which can be a cause of severe morbidity and mortality if left unaddressed
Summary
Proton-pump inhibitors (PPIs) are a class of drugs that are widely used for the treatment of a variety of gastric acid-related disorders, including peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) [1]. They are routinely used in the treatment of upper gastrointestinal bleeds (UGIBs) [2]. PPIs are commonly prescribed medications that are considered to be generally safe and well-tolerated These drugs account for approximately 95% of all acid-suppressing medication prescriptions due to their effectiveness and side-effect profile [6]. The adverse effects of long-term use that have been reported include increased risk of enteric infection, chronic atrophic gastritis, drug-induced lupus, acute interstitial nephritis, thrombocytopenia, and malabsorption of various nutrients like iron, vitamin B12, and magnesium [6-12]
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