Proton pump inhibitors: An incisive review (original) (raw)

Proton Pump Inhibitors Present and Future a Review

Proton pump inhibitors (PPIs) are very effective drugs used largely in acid related disorders. Since their introduction into clinical practice almost two decades ago, PPIs have revolutionized the medical treatment of acid related disorders. Oesophageal mucosal healing has made PPIs the first choice treatment not only for reflux disease but also for other acid related diseases. This review includes physiology of acid secretion, acid related disorders which are arise due to excessive released of gastric acid, proton pump, PPIs and its classification, pharmacology of PPIs, Clinical significance of PPIs, adverse effect of PPIs and advancement in different PPIs. Although PPIs are very effective drugs they are still far from the ideal antisecretory compound and display a number of shortcomings. A number of new drugs are currently being investigated to vide a significant advance on current treatments. Some of them have already reached clinical testing while some other are still in preclinical development and need the proof of concept in human beings. In this connection, new formulations, novel compounds and better acid-suppressing regimens are welcome.

Adverse Effects of Proton Pump Inhibitors—Evidence and Plausibility

International Journal of Molecular Sciences, 2019

Proton pump inhibitors (PPIs) have been increasingly used over the last decades and there are concerns about overuse and the numerous reported side-effects. It is uncertain whether associations between PPI use and potential side effects are causal. However, important evidence from experimental and mechanistic studies that could support a causal relationship may have been underestimated by epidemiologists and meta-analysists. In the current manuscript we review the combined epidemiological and mechanistic evidence of the adverse effects of PPI use.

Safety of Long-Term Proton Pump Inhibitors: Facts and Myths

Arquivos de Gastroenterologia

Background: Proton pump inhibitors (PPIs) are one of the most prescribed drugs in the world. Frequent use and long-term maintenance of these drugs drew the attention of researchers for sporadic adverse effects reports. Objective: The purpose of this narrative review is to discuss appropriate data and causality related to these adverse events and PPIs. Methods: A narrative review was conducted by systematizing information about safety and adverse events on PPIs from 2015 to 2020. A structured search on Pubmed was performed to identify systematic reviews and meta-analysis investigating the following situations: a) gastric cancer; b) micronutrients deficiency; c) acid rebound; d) infections; e) fractures; f) dementia; g) kidney disease; and h) sudden death and cardiovascular changes. Results: Recent studies have potentially associated PPIs with some adverse events as osteoporosis-related fractures. There are also reports of intestinal infections, including Clostridium difficile, beside...

Proton pump inhibitors: the beginning of the end or the end of the beginning?

Current Opinion in Pharmacology, 2008

Despite the dramatic success of pharmacological acid suppression in healing peptic ulcers (PUs) and managing patients with gastro-esophageal reflux disease (GERD) a number of challenges remain in the management of acidrelated disorders. Several new drugs are currently being investigated to provide a significant advance over current treatments. These include new drug formulations, novel proton pump inhibitors (PPIs) as well as potassium-competitive acid blockers (P-CABs), which have already reached clinical testing. Some others (like NO-releasing antisecretory compounds) are still in preclinical development and require proof of concept in humans. While H 2-receptor antagonists (especially soluble or OTC formulations) will become the 'antacids of the third millennium' and will be particularly useful for on-demand symptom relief, clinicians will continue to rely on PPIs to control acid secretion in GERD and other acid-related diseases. Since an increasing proportion of patients fail to respond to the best PPI treatment, more potent and long-acting drugs and more effective regimens are needed.

Intravenous Proton Pump Inhibitors

Drugs, 2009

Conditions requiring inhibition of acid secretion, such as gastrooesophageal reflux disease or peptic ulcers, are very common and their prevalence is expected to rise as they are seen predominantly in the elderly. The general basis of treatment with antisecretory agents is to maintain gastric pH >4 for a substantial proportion of the 24-hour cycle. Among the drugs available to inhibit acid secretion, proton pump inhibitors (PPIs) have been shown to have the best benefit-risk ratio and have been used widely. Intravenous administration of a PPI provides gastric acid suppression faster than oral administration does. Whereas some indications for the use of

Long Term Risks of Proton Pump Inhibitor Administration: A Literature Review

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy, 2018

Proton pump inhibitor (PPI) has become drug of choice for acid related disease. However, PPI tend to be overprescribed and becoming one of the highest burden for health cost. Some studies showed that PPI are prescribed unnecessarily. Recent evidences showed raised concerns over long term effects of PPI consumption. Several long term side effects such as increased incidence of gastric polyps, micronutrient absorption disorders, infections, and osteoporosis have been yearly discussed. In recent years there has been increased attention to new side effects such as dementia, chronic renal failure, and cardiovascular disorders. Therefore, some health associations had issued warning and guidance regarding long term PPI prescription.

INAPPROPRIATE USE OF PROTON PUMP INHIBITORS, TIME TO REASSESS INDICATIONS

Ghulam Fareed, Hasham Nawaz, Wajid Iqbal, SM. Nabeel Noor, Shahab Abid

Introduction: Proton pump inhibitors are one of the most commonly prescribed and most commonly used medications worldwide, both in primary, secondary, and tertiary care settings. In the majority of cases, they are used inappropriately without any clear-cut indication hence leading to lots of unnecessary health related costs both nationally and internationally. Also, misuse is associated with potential complications. Due to the current dearth of available data regarding use and misuse of PPIs in Pakistan, there is an urgent need to assess appropriateness of PPI use both in primary and tertiary care settings to avoid the potentially devastating financial and public health concerns. Materials and Methods: It is a retrospective observational study conducted in department of medicine, Aga khan university hospital karachi, over a period of one year. There was total 13,346 patients admitted in the hospital during the specified period under care of Medicine and allied 6950/13346 (52%), OBGYN 379/13346 (3%) and General surgery and allied 6017/13346 (45%). Estimated sample size was 980 patients and similar percentages of patients were taken from above groups via simple random sampling Results: Out of 797 patients, 367 (46%) had an FDA-approved indication for PPIs use, 213 (26.7%) had alternate indications as recommended by clinical practice guidelines whereas remaining 217 patients (27.2%) were treated with PPI without any approved indications Conclusion: The results of this study showed that every fourth patient in hospital is getting PPIs without fulfilling indications as per established evidence based clinical practice guidelines. Key Words: Proton pump inhibitor, PPIS misuse, Financial and health concerns, Approved indications, Inappropriate indications, potential complications

Long Term Use of Proton Pump Inhibitors: Where to Draw the Line

Integrative Gastroenterology and Hepatology, 2018

Proton pump inhibitors are the leading evidence-based therapy for acid related upper gastrointestinal disorders including dyspepsia, GERD and peptic ulcer disease. These are among the most frequently prescribed drugs globally. However, PPIs have been subjected to studies and have been associated with increased risk of adverse effects like Clostridium difficile-associated diarrhea, community-acquired pneumonia, bone fracture, reduced intestinal absorption of vitamins and minerals, and more recently kidney damage and dementia etc. In this review the recent literature regarding these adverse effects and their association with long-term proton pump inhibitor treatment is discussed. The objective of this review is to analyse the potential adverse effects of long-term PPI use and summarize the clinical implications. We documented a considerable increase in the use of PPIs over the last decade. This increase is due to over-prescription and use of PPIs for inappropriate indications. On the ...