Side Effects Of Proton Pump Inhibitors Research Articles

Proton pump inhibitors in esophageal atresia: A systematic review and meta-analysis.

Gastroesophageal reflux disease (GERD) is frequent and prolonged in esophageal atresia (EA) pediatric patients requiring routine use of proton pump inhibitors (PPIs). However, there are still controversies on the prophylactic use of PPIs and the efficacy of PPIs on GERD and EA complications in this special condition. The aim of the study is to assess the prophylactic use of PPIs in pediatric patients with EAand its complications. We, therefore, performed a systematic review including all reports on the subject from 1980 to 2022. We conducted meta-analysis of the pooled proportion of PPI-and no PPI groups using random effect model, meta-regression, and estimate heterogeneity by heterogeneity index I2 . Thirty-eight reports on the topic met the criteria selection, representing a cumulative 6044 patients with EA. Prophylactic PPI prescription during the first year of life does not appear to prevent GERD persistence at follow-up and is not associated with a significantly reduced rate of antireflux surgical procedures (ARP). PPIs improve peptic esophagitis and induce remission of eosinophilic esophagitis at a rate of 50%. Their effect on other GERD outcomes is uncertain. Evidence suggests that PPIs do not prevent anastomotic stricture, Barrett's esophagus, or respiratory complications. PPI use in EA can improve peptic and eosinophilic esophagitis but is ineffective on the other EA complications. Side effects of PPIs in EA are almost unknown.

Testing Lansoprazole on Human Gut Microbiota using a Gastroesophageal Reflux Model In Vitro

One in five Americans experience Gastroesophageal Reflux Disease, but the disease has multiple treatments, such as Proton Pump Inhibitors (PPI). However, the effects of PPIs may induce more harmful effects on the gut microbiome, and less treatable symptoms such as inflammatory bowel disease, diabetes, obesity, and even cancer may occur. PPIs reduce acid secretion within the stomach and reduce stomach acid in the esophagus. The side effects of PPIs on the gut microbiome have yet to be researched extensively. This study suggests that Lansoprazole, a PPI, may cause significant changes in gut bacteria growth. An adapted method of in vitro digestion modeled the digestive systems of a human. Solutions replicating the environment of the mouth, stomach, and intestines were combined with a human dosage of Lansoprazole, and the pH was adjusted at different segments to model the low pH environments of the stomach and the neutral pH of the intestines. The respective solutions were then exposed to gut bacteria, E. coli, and S. epidermidis. These gut bacterias represent specific bacteria species within the intestinal tract. Data indicated that E. coli grew approximately 50% as much as the control at 20-minutes and less than 25% as much as the control at 40-minutes. S. epidermidis grew significantly less than the control, with approximately 60% as much at 20-minutes and approximately 15% as much at 40-minutes. In conclusion, studies indicate Lansoprazole treats GERD, but side effects from consuming the drug may cause gut dysbiosis, which may lead to the side effects previously mentioned.

Comparing the Safety and Efficacy of Proton Pump Inhibitors and Histamine-2 Receptor Antagonists in the Management of Patients With Peptic Ulcer Disease: A Systematic Review.

Peptic ulcer disease (PUD) refers to the occurrence of an open erosion in the inner lining of the stomach, duodenum, or sometimes lower esophagus. Treatments like proton pump inhibitors (PPIs) or histamine 2 receptor antagonists (H2RAs) are available on the market to efficiently treat the break in the mucosal lining. However, there is little evidence about the effects of the medication on the type and location of the ulcer and the epigastric pain caused by disintegration and increased acidity in the stomach. Given the above, we conducted a systematic review comparing the safety and efficacy of PPIs and H2RAs in various ulcer locations (gastric, duodenal, and pre-pyloric) and the effect of prolonging the treatment with the same medication or changing into a drug from another class in treatment-resistant ulcers. We employed major research literature databases and search engines such as PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Science Direct, and Google Scholar to find relevant articles. After a thorough screening, a quality check using various tools, and applying filters that suited our eligibility criteria, we identified eight articles, of which five were random clinical trials (RCTs), two review articles, and one meta-analysis. This study compares the different side effects of PPIs and H2RAs. Most studies concluded that omeprazole is superior in healing ulcers and bringing pain relief and that patients resistant to H2RAs can be treated better when switched to a PPI. This study also discusses the adverse effects of chronic use, such as diarrhea, constipation, headaches, and gastrointestinal infections. Patients on long-term PPI therapy are required to take calcium supplements to prevent the risk of fractures in older adults. Regarding long-term outcomes, PPIs remain the mainstay of treatment for peptic ulcer disease, based on the papers we reviewed.

Current use of proton pump inhibitors and when to limit, stop or not start treatment

Proton pump inhibitors (PPIs) are potent inhibitors of gastric acid secretion that have changed treatment practice for gastric acid-related disorders. The major adequate indications for their use are treatment of gastro-esophageal reflux disease, peptic ulcers, eradication of Helicobacter pylori infection in combination with antibiotics and prophylaxis for patients on non-steroidal anti-inflammatory or antiplatelet drugs. Since their introduction, clinical success has been accompanied by widespread use of PPIs, which has steadily increased over the last decades without concomitant increase in the incidence of acid-related disorders. PPIs are now among the most widely prescribed class of medications worldwide and around 10% of Icelanders are current PPI users. This increase has been linked to PPI prescription without an indication, or continued use for longer duration than recommended. In recent years, concerns have been raised about PPI overuse and the associated increased risk of harm, not only in terms of increased costs but also the potential risk of physical dependence and long-term side effects of PPIs. The article is based on search in PubMed, the authors' own clinical experience and research, and is intended to provide practice advice on the use of PPIs with focus on appropriate prescription and deprescription of PPIs.

#3386 PROTON-PUMP INHIBITORS AND SERUM CONCENTRATIONS OF UREMIC TOXINS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Use of proton-pump inhibitors (PPIs) is common in patients with chronic kidney disease (CKD). PPIs and many uremic toxins (UTs) are eliminated by a kidney tubular organic anion transporter system. In a cross-sectional study, we sought to evaluate the association between PPI prescription and serum concentrations of various UTs. Method We studied a randomly selected subgroup of participants in the CKD-REIN prospective cohort (adult patients with a confirmed diagnosis of CKD and estimated glomerular filtration rate (eGFR) <60ml/min/1.73m²) with available frozen samples collected at baseline. PPI prescription was recorded at baseline. Serum concentrations of 10 UTs were measured using a validated liquid chromatography tandem mass spectrometry technique. Multiple linear regression was performed, with the log UT concentration as the dependent variable. Results Of the 680 included patients [median age: 68 years; median eGFR: 32 ml/min/1.73 m2], 31% had PPI prescriptions at baseline. Patients using PPIs had higher levels of certain UTs in comparison to other patients, including total and free indoxyl sulfate (IS), total and free p-cresylsulfate, total and free p-cresylglucuronide (PCG), phenylacetylglutamine (PAG), free kynurenine, and free hippuric acid. After adjustment for baseline comorbidities, number of co-prescribed drugs and laboratory data including eGFR, associations between PPI prescription and elevated serum concentrations of free and total IS, free and total PCG, and PAG remained significant. Conclusion Our results indicate that PPI prescription is independently associated with serum UT retention. These findings indicate a potential mechanism for side effect of PPIs in CKD patients that will need to be confirmed by longitudinal studies.

Is an optimization of the use of proton pump inhibitors feasible in the real world medical practice?

The review deals with the data on negative health impact of prolonged and inadequate use of proton pump inhibitors (PPI). Since their advent at the end of 1980s, their worldwide use has been continuously increasing. However, up to 70% of PPI use is not based on clear indications. Inadequate treatment with PPI not complying with clinical guidelines results in a higher risk of adverse events, especially in the elderly. Prolonged (more than 8 weeks) intake of PPI increases the risk of osteoporotic fractures, promotes Clostridioides difficile infection and gut microbiota abnormalities, community-acquired pneumonia, vitamin B12 deficiency, renal disease, dementia, risk of gastric cancer, etc. Most potential side effects of PPI are the results of hypochlorhydria and reflex hypergastrinemia. The main safety principle for PPI is adherence to short duration of treatment and minimally effective doses. Rational strategies for safe and effective PPI treatment are supported by the evidence-based deprescribing in gastroesophageal reflux disease and include dose tapering or therapy as needed after the treatment course for a specific indication has been finished, or stopping the treatment in patients with no adequate indications to PPI administration. Increased awareness of medical personnel and patients on the proper PPI use and their side effects would make it possible to optimize the use of these agents in the real world medical practice.

Pantoprazole-Associated Thrombocytopenia: A Literature Review and Case Report

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.

Evaluate the effectiveness and safety of proton pump inhibitors (PPIs) in the treatment of upper GIT disorders

Introduction: Proton pump inhibitors (PPIs) are most prescribed medication classes and have similar efficacy between generic and brand names. PPIs are used for treatment upper GIT disorders. The aim of the present study was to evaluate the effectiveness and safety of proton pump inhibitors (PPIs). Methods: A cross sectional study conducted randomly on pharmacies, patients and Doctors to collect a data regarding the effectiveness and safely use of PPI through predesigned questionnaire containing information about dosage, types, side effect, effectiveness and safety of PPIs. The collected data was analysis by using Chi-square for determine the significant differences at α < 0.05. Result: The result of present study revealed numbers of points in which the questionnaire were intended for pharmacies, patients and doctors knowledge, effectiveness and safety of PPIs. The data gathered from pharmacy shown PPI dispensed without prescription (P< 0.05) in dose of 20 mg of omeprazole and for treatment of gastritis, stomachache and on medication use (P< 0.05). No side effect or any problem, safe, and effective of PPIs was from patients seeking PPIs to the drug dispensers. Furthermore, questionnaire for patients whom seeking treatment shown some similarity to pharmacies answers, however lack the knowledge about side effect of PPIs, and PPIs withdraw among patients. PPIs was found to be used by patients due to the advices of friends (P< 0.05). The last part in this study was doctors involved in which some common similarity were also identified between doctors, patients and pharmacies responses. Although, Doctors responses were revealed that PPIs should be used by prescription in single dose of common types of PPIs (P< 0.05). Conclusion: Due to the short time use of PPIs have been reported. This study suggested that, even no side effect and highly effective of PPIs reported, the PPIs should be monitoring and use under prescription.

Proton Pump Inhibitors and Primary Liver Cancer

During the last years proton pump inhibitors (PPIs), previously regarded as very safe drugs and allowed to be sold over the counter, have been reported to give side effects in many organ systems. However, most of these negative reports probably are due to residual confounding factors. In general, the side effects of PPIs are due to their biological effect in removing the biological effect of gastric juice that is killing microorganisms, and the secondary hypergastrinemia in an unsuccessful attempt to restore normal gastric acidity. Whereas the possibility that hypergastrinemia could predispose to gastric cancer has been permanently on the agenda since the introduction of PPIs, the removal of the important protective effect towards microbes has surprisingly only been focused on during the later years as a consequence of increased interest on the gut microbiome. PPI treatment affects the microbiome, and it exists one report describing increased risk of primary liver cancer due to PPI use. Changes in the gut microbiome have been shown to participate in the pathogenesis of chronic liver diseases caused by ethanol as well as obesity. In general, chronic liver diseases predispose to liver cancer. There are also rodent studies incriminating inhibition of gastric acid secretion in the pathogenesis of primary liver cancer. However, it must be concluded that presently the role of PPIs in the development of primary liver cancer seems weak.

Dermatologic adverse reactions to proton‐pump inhibitors: A synthetized review

Proton-pump inhibitors (PPIs) are one of the most prescribed drugs. Their dermatological adverse reactions are multiple and vary in severity. This review discusses all reported cutaneous side effects of PPIs in order to help physicians understand them and provide appropriate management. A thorough search of PubMed, Embase, and FDAAQ8 drugs websites was conducted. 56 articles including case reports, case series, and review articles of PPI-induced cutaneous adverse reactions were selected. Data were recorded regarding patient age, gender, history, clinical manifestations, diagnostic tests, management, and clinical outcomes. PPI-induced adverse skin reactions are mostly immunological and include both immediate and delayed-type hypersensitivity reactions. These reactions are sometimes life-threatening. All PPIs can induce immediate IgE-mediated reactions. Most of previously published cases of delayed-type hypersensitivity reactions have involved esomeprazole, omeprazole, and lansoprazole. Skin tests are helpful in confirming PPI-induced hypersensitivity reactions and diagnosing potential cross-reactivities. PPIs should also be added to our list of usual suspects when considering possible culprits for a new presentation of drug-induced subacute lupus erythematosus. PPI-related occupational contact dermatitis has also been numerously reported. PPIs should be considered in our list of culprits when considering a patient with a cutaneous drug reaction, taking into account that these drugs can cause severe immunological manifestations.

Clinical course of gastroesophageal reflux disease and impact of treatment in symptomatic young patients.

In symptomatic young patients with gastroesophageal reflux symptoms, early identification of progressive gastroesophageal reflux disease (GERD) is critical to prevent long-term complications associated with hiatal hernia, increased esophageal acid and nonacid exposure, release of proinflammatory cytokines, and development of intestinal metaplasia, endoscopically visible Barrett's esophagus, and dysplasia leading to esophageal adenocarcinoma. Progression of GERD may occur in asymptomatic patients and in those under continuous acid-suppressive medication. The long-term side effects of proton-pump inhibitors, chemopreventive agents, and radiofrequency ablation are contentious. In patients with early-stage disease, when the lower esophageal sphincter function is still preserved and before endoscopically visible Barrett's esophagus develops, novel laparoscopic procedures, such as magnetic and electric sphincter augmentation, may have a greater role than conventional surgical therapy. A multidisciplinary approach to GERD by a dedicated team of gastroenterologists and surgeons might impact the patients' lifestyle, the therapeutic choices, and the course of the disease. Biological markers are needed to precisely assess the risk of disease progression and to tailor surveillance, ablation, and management.

Proton Pump Inhibitors and Dementia

Proton Pump Inhibitors and Dementia

The Impact of Direct-to-Consumer Pharmaceutical Advertising on Public Knowledge of Gastroesophageal Reflux Disease: A Study on Over-the-Counter Proton Pump Inhibitors.

BackgroundThe use of direct-to-consumer advertising (DTCA) to promote sales of over-the-counter (OTC) pharmaceuticals used to manage common medical conditions, such as gastroesophageal reflux disease (GERD), is increasing. However, the educational value of these advertisements as well as the public perceptions of this type of advertising remain largely unknown among non-English speaking populations.ObjectiveThe aim of this study was to explore the public perceptions and educational value of a short motion graphic video documenting the lifestyle of person with GERD and presenting a brief introduction to the role of proton pump Inhibitors (PPIs) in relieving the symptoms.MethodsThis was a prospective quasi-experimental study in which a short mock advertising motion graphic video was shown to a sample of adult individuals in malls and shopping centers in different cities across Saudi Arabia. Participants were required to express their levels of agreement with six statements concerning their perceptions of DTCA of OTC drugs, and answer a quiz consisting of three questions and enquiries about their knowledge of GERD and the OTC drugs used in its treatment.ResultsTwo hundred and ninety-five participants were involved in this study, the majority of whom were female (55.30%). After watching the video, the percentages of participants who strongly agreed or agreed that DTCA is a credible source of information and encourages them to purchase the marketed drug have increased significantly (P<0.05). With regard to the quiz, the percentages of participants with correct answers regarding the definition of GERD, knowledge of OTC drugs for GERD, and awareness of the common side effects of PPIs increased from 81.69% to 95.93%, 69.83% to 96.27%, and 46.44% to 91.53%, respectively (P<0.0001).ConclusionDTCA of OTC drugs for GERD, particularly if the content complies with the regulatory requirements, can promote the public knowledge of the disease and treatment options.

Side Effects of Proton Pump Inhibitors: What are Patients’ Concerns?

Proton pump inhibitors (PPIs) are the fourth most widely sold drugs in the United States. Mounting evidence suggests PPIs may not be as safe as originally thought. We hypothesize that increased awareness of PPI side effects and patient education may influence patient interest in PPI use and compliance. We aimed to investigate patient concerns and education regarding PPI use and side effects. Prospective questionnaire. Tertiary care center. Consecutive patients with a diagnosis of gastroesophageal or laryngopharyngeal reflux currently on PPI, or having discontinued PPIs within 6 months, completed a questionnaire regarding level of concern regarding PPI side effects and level of education. Fifty consecutive patients completed the questionnaire. The mean age was 64 (±12.2) years and 47.8% was male. The majority of surveyed patients (52.2%) were concerned about the side effects of PPIs. Among these patients, the most common concerns were increased bone fracture (23.9%) and cardiovascular risk (21.7%). The most common source of PPI side-effect information was healthcare professionals (45.7%). Age, specific type of concern, side-effect experience, and reflux symptom index scores, but not level of education, proved to be statistically significant predictor variables for patients' overall concern with taking PPI, based on logistic regression. There was a high prevalence of concern regarding PPI side effects in patients with reflux. The most common concern was bone fracture. Level of education was not associated with greater concern for PPI side effects.

The Use of Proton Pump Inhibitors May Increase Symptoms of Muscle Function Loss in Patients with Chronic Illnesses.

Long-term use of proton pump inhibitors (PPIs) is common in patients with muscle wasting-related chronic diseases. We explored the hypothesis that the use of PPIs may contribute to a reduction in muscle mass and function in these patients. Literature indicates that a PPI-induced reduction in acidity of the gastrointestinal tract can decrease the absorption of, amongst others, magnesium. Low levels of magnesium are associated with impaired muscle function. This unwanted side-effect of PPIs on muscle function has been described in different disease backgrounds. Furthermore, magnesium is necessary for activation of vitamin D. Low vitamin D and magnesium levels together can lead to increased inflammation involved in muscle wasting. In addition, PPI use has been described to alter the microbiota’s composition in the gut, which might lead to increased inflammation. However, PPIs are often provided together with nonsteroidal anti-inflammatory drugs (NSAIDs), which are anti-inflammatory. In the presence of obesity, additional mechanisms could further contribute to muscle alterations. In conclusion, use of PPIs has been reported to contribute to muscle function loss. Whether this will add to the risk factor for development of muscle function loss in patients with chronic disease needs further investigation.

Drug use is associated with lower plasma magnesium levels in geriatric outpatients; possible clinical relevance

Hypomagnesemia has been associated with diabetes, cardiovascular disease, and other disorders. Drug use has been suggested as one of the risk factors for low magnesium (Mg) levels. In the elderly population, prone to polypharmacy and inadequate Mg intake, hypomagnesemia might be relevant. Therefore, we aimed to investigate associations between drug use and plasma Mg. Cross-sectional data of 343 Dutch geriatric outpatients were analysed by Cox and linear regression, while adjusting for covariates. Drug groups were coded according to the Anatomical Therapeutic Chemical classification system; use was compared to non-use. Hypomagnesemia was defined as plasma Mg<0.75mmol/l and <0.70mmol/l. Prevalence of hypomagnesemia was 22.2% (Mg<0.75mmol/l) or 12.2% (Mg<0.70mmol/l); 67.6% of the patients used ≥5 medications (polypharmacy). The number of different drugs used was inversely linearly associated with Mg level (beta-0.01; p<0.01). Fully adjusted Cox regression showed significant associations of polypharmacy with hypomagnesemia (Mg<0.75mmol/l) (prevalence ratio (PR) 1.81; 95%CI 1.08-3.14), proton pump inhibitors (PR 1.80; 95%CI 1.20-2.72), and metformin (PR 2.34; 95%CI 1.56-3.50). Moreover, stratified analyses pointed towards associations with calcium supplements (PR 2.26; 95%CI 1.20-4.26), insulins (PR 3.88; 95%CI 2.19-6.86), vitamin K antagonists (PR 2.01; 95%CI 1.05-3.85), statins (PR 2.44; 95%CI 1.31-4.56), and bisphosphonates (PR 2.97; 95%CI 1.65-5.36) in patients <80 years; selective beta blockers (PR 2.01; 95%CI 1.19-3.40) if BMI <27.0kg/m2; and adrenergic inhalants in male users (PR 3.62; 95%CI 1.73-7.56). Linear regression supported these associations. As polypharmacy and several medications are associated with hypomagnesemia, Mg merits more attention, particularly in diabetes, cardiovascular disease, and in side-effects of proton pump inhibitors and calcium supplements.

Gastrointestinal Side Effects of Proton Pump Inhibitors on Inpatients at Gatot Soebroto Hospital

Introduction: Gastrointestinal side effects of proton pump inhibitors (PPI) medicines can be diarrhea and constipation. Objective: The purpose of this study was to prospectively analyse gastrointestinal side effects of PPIs used by inpatients of Gatot Subroto Hospital. Material and Methods: This descriptive analytic study collected data prospectively from prescriptions and patient medical records and through an interview with valid and reliable questionnaire. Causality analysis of gastrointestinal side effects was done by using Naranjo Algorithm while Chi-square and Fisher absolute test were used to see the association between gastrointestinal side effect and gender, age, PPI’s dose, and duration of administration of PPI. Samples were patients who were ≥ 17 years old, received proton pump inhibitor and signed the Informed Consent. Results: The data were collected from February to April 2016 by total sampling method. From 58 patients as research samples, nineteen patients (32.75%) experienced constipation which 16 patients (27.58) and 3 patients (5.17%) were with probable and possible category, respectively. None experienced diarrhea. There were no significant association between constipation and sex, age, PPI’s dose and the duration of PPI’s. Conclusion: Constipation was the most common gastrointestinal side effect that was not related to age, sex, PPI dose, and duration of PPI administration. Key words: Constipation, Naranjo algorithm, Proton Pump Inhibitor, Side effect, Dengue high fever, Gatot Soebroto hospital.

Do Recent Reports About the Adverse Effects of Proton Pump Inhibitors Change Providersʼ Prescription Practice?

Introduction: Proton pump inhibitors (PPI) are indicated to treat gastroesophageal reflux disease, peptic ulcer disease, dyspepsia and to prevent GI bleeding. Studies have shown increasing inappropriate PPI use. Recent reports in the press and social media have highlighted new data suggesting a possible link between chronic PPI use and several medical problems, leading to frequent patient inquiries about these associations. Providers face the challenges of balancing PPI benefits and risks. We aimed to explore providers' knowledge and attitudes toward reported adverse effects of PPI and compare gastrointestinal (GI) and Non-GI providers' prescription practices.Table 1: Concerning side effects PPI to the patients reported by providersTable 2: Concerning side effects of PPI to providersFigure 1Methods: A comprehensive non-incentivized electronic survey was sent to all providers (residents, fellows, advanced practice providers and consultants across seven specialties) at a tertiary academic center. The survey contained 21 questions covering the following provider aspects: (1) demographics (2) responses to challenging clinical scenarios dealing with PPI use. Chi-square was used to compare responses from GI providers to those from non-GI providers. Results: We sent the survey to 254 providers at our center. 88 providers (22 GI and 66 non-GI) completed the survey (34.6 % response rate). Non-GI providers included cardiology, pulmonary medicine, endocrinology, family medicine, general internal medicine, hematology/oncology, and nephrology. More GI providers reported that these potential side effects changed their practice (63.6% in GI vs 48.5 in non-GI, p-value 0.4). A larger percentage of GI providers lowered the dose of PPI (18.2 % vs 1.5% p-value 0.003). Table (1) shows what providers do when facing challenging patients on PPI therapy. When asked which side effects are more concerning to patients, GI providers were more likely to cite osteoporosis or fractures than non-GI providers (40.9% vs 15.1% p-value 0.01) and dementia (31.8% vs 25.8 p-value 0.58). Table (2) and (3) show concerning side effects per patients and providers, respectively. Most providers (GI and non-GI) agreed that educational activities (e.g. grand rounds), would be helpful to address these challenges (95.5% vs 89.4%, p-value 0.67). Conclusion: Educating patients and providers about potential side effects of PPI is imperative. More GI providers reduced the dose of PPI for their patients while more non-GI providers switched to another medication (e.g. H2 blockers) or referred to GI clinic. Educational activities might be helpful in addressing these challenges.

Dietary Inulin Fibers Prevent Proton-Pump Inhibitor (PPI)-Induced Hypocalcemia in Mice.

BackgroundProton-pump inhibitor-induced hypomagnesemia (PPIH) is the most recognized side effect of proton-pump inhibitors (PPIs). Additionally, PPIH is associated with hypocalcemia and hypokalemia. It is hypothesized that PPIs reduce epithelial proton secretion and thereby increase the pH in the colon, which may explain the reduced absorption of and Mg2+ and Ca2+. Fermentation of dietary oligofructose-enriched inulin fibers by the microflora leads to acidification of the intestinal lumen and by this enhances mineral uptake. This study aimed, therefore, to improve mineral absorption by application of dietary inulin to counteract PPIH.MethodsHere, C57BL/J6 mice were supplemented with omeprazole and/or inulin. Subsequently, Mg2+ and Ca2+ homeostasis was assessed by means of serum, urine and fecal electrolyte measurements. Moreover, the mRNA levels of magnesiotropic and calciotropic genes were examined in the large intestine and kidney by real-time PCR.ResultsTreatment with omeprazole significantly reduced serum Mg2+ and Ca2+ levels. However, concomitant addition of dietary inulin fibers normalized serum Ca2+ but not serum Mg2+ concentrations. Inulin abolished enhanced expression of Trpv6 and S100g in the colon by omeprazole. Additionally, intestinal and renal mRNA levels of the Trpm6 gene were reduced after inulin intake.ConclusionsThis study suggests that dietary inulin counteracts reduced intestinal Ca2+ absorption upon PPI treatment. In contrast, inulin did not increase intestinal absorption of Mg2+ sufficiently to recover serum Mg2+. The clinical potential of dietary inulin treatment should be the subject of future studies.

Pantoprazole-induced thrombocytopenia in patients with upper gastrointestinal bleeding

Proton pump inhibitors (PPIs) are highly effective drugs for patients suffering from peptic ulcer and gastro-esophageal reflux diseases, but recent studies have indicated possible risks with the long-term use of PPIs, such as osteoporosis, fractures, increased risk of pneumonia, diarrhea, iron and vitamin B12 deficiencies. There are publications written as a case study that indicate thrombocytopenia as side effects of PPIs, but there is no study on this subject. This study aimed to investigate the development of thrombocytopenia in patients with short-term use of PPI-infusion therapy. In this study, the records of the patients were evaluated retrospectively, for the period between January 2012 and January 2013. Thirty-five patients with upper gastrointestinal bleeding were enrolled. Platelet counts were analyzed before treatment, and on the first, second and third day of treatment, respectively. All patients were treated with intravenous pantoprazole. Hemogram values of patients were analyzed before and after PPI infusion treatment. Platelet counts were found to decrease from the first day to the third day of treatment (249 714.29/µl, 197 314.29/µl, 193 941.18/µl, 183 500/µl, respectively). The platelet count decrease was statistically significant (p < 0.001). After cessation of infusion therapy, platelet counts began to rise on the fourth day. Three patients had severe thrombocytopenia on the third day of the treatment. (69 000/µl, 97 000/µl and 49 000/µl respectively). Platelet counts recovered after discontinuation of treatment. In conclusion, this study demonstrates that PPIs may cause thrombocytopenia, and this result should not be ignored. In particular, patients with PPI infusion therapy should be monitored more closely.