Side Effects Of Proton Pump Inhibitors Research Articles

Proton pump inhibitor therapy and potential long-term harm

This review summarizes the recent literature on the potential side-effects of proton pump inhibitors (PPIs) and known interactions with the metabolism/absorption of other drugs. Data confirm that PPIs are a very well tolerated drug class. Their high safety, efficacy and wide distribution lead to overuse, inappropriate dosage or excessive duration of treatment. Despite the absorption of micronutrients or other plausible effects on the development of bacterial infections linked to PPI-induced hypochlorhydria, it is difficult to demonstrate an association between PPI and specific symptoms. A possible negative effect of PPIs on bone integrity appears weak, but hypomagnesemia is likely a PPI drug class effect. A higher risk of Clostridium difficile infection and other infectious diseases such as small intestinal bacterial overgrowth and spontaneous bacterial peritonitis remain controversial in PPI users. However, the careful use of PPIs in cirrhotic or otherwise fragile patients is mandatory. Short-term or long-term PPI use may trigger microscopic colitis, and the management of this condition may include PPI withdrawal. The effect of PPIs on stimulating exocrine or endocrine gastric cell proliferation is poorly understood. A diagnostic delay or masking of diseases such as gastrinoma is difficult to evaluate. Short-term standard dose PPI treatment is low risk. Long-term PPI use may complicate health conditions by various mechanisms linked to PPIs and/or to hypochlorhydria.

Stressläsionen im oberen Gastrointestinaltrakt

Clinically relevant bleeding in the upper gastrointestinal tract due to stress lesions is a rare event; however, the related mortality may be as high as 13% (van Leerdam, Best Pract Res Clin Gastroenterol 2008; 22:209-224). Most often affected are patients in the intensive care unit (ICU) with impaired perfusion as the protective pathways are critically dependent on a near normal blood flow. Minimal mucosal lesions with a tiny hemorrhage can escalate to severe bleeding as the coagulation potential in the presence of an acidic pH is clearly decreased. Mechanical ventilation and coagulopathy are recognized risk factors and these patients should receive an acid suppressing therapy. Proton pump inhibitors (PPI) and histamine type 2 receptor antagonists (H(2)RA) are equal in their ability to prevent stress-related bleeding. However, the side effects of PPI can cause severe morbidity and therefore H(2)RAs may be the drug of choice for prophylaxis. Endoscopy is recommended as a diagnostic and therapeutic tool for patients with active bleeding. Treatment with PPI in this scenario (before and after endoscopy) may reduce complications by leading to premature hemostasis and reduced recurrence of bleeding.

Proton pump inhibitor-induced hypomagnesemia: A new challenge

Proton pump inhibitors (PPIs) are commonly used in clinical practice for the prevention and treatment of peptic ulcer, gastritis, esophagitis and gastroesophageal reflux. Hypomagnesemia has recently been recognized as a side effect of PPIs. Low magnesium levels may cause symptoms from several systems, some of which being potentially serious, such as tetany, seizures and arrhythmias. It seems that PPIs affect the gastrointestinal absorption of magnesium. Clinicians should be vigilant in order to timely consider and prevent or reverse hypomagnesemia in patients who take PPIs, especially if they are prone to this electrolyte disorder.

Effect of proton pump inhibitor on amylase release from isolated pancreatic acini

Proton pump inhibitors (PPIs) could inhibit the secretion of gastric acid. Meanwhile, it could also decrease the secretion of other digestive glands besides gastric parietal cell. As we know, PPIs have been widely used to treat acute pancreatitis, and it is effective in clinical practice. However, research showed the side effect of PPIs on acute pancreatitis. The direct effect of PPI on pancreatic secretion is still unknown. Our experiment investigated the direct effect of PPIs on pancreatic exocrine by isolated pancreatic acini. In our study, isolated pancreatic acini were prepared as previously described by Williams, and cerulein was added to stimulate its secretion. The amylase release in the suspension was determined after the administration of different concentrations of omeprazole and Sandostatin; and its activity was also observed in different time phases. In our in vitro study, all results suggest that omeprazole has no direct repression on amylase release from isolated pancreatic acini.