Long Term Use of Proton Pump Inhibitors and Associated Adverse Events: A Complex and Multidimensional Clinical Issue V

Iqbal Akhtar Khan 

Independent Scholar, Lahore -54792, Pakistan 

Correspondence: Iqbal Akhtar Khan, Independent Scholar, Lahore-54792, Pakistan, Email [email protected] 

Received: October 02, 2023                                                                                                                             Published: October 29, 2023

Citation: Iqbal AK. Long Term Use of Proton Pump Inhibitors and Associated Adverse Events: A Complex and Multidimensional Clinical Issue. AOJ Emerg and Int Med. 2023;1(1):25–38. 

Copyright: ©2023 Khan. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially.

Abstract 

Background 

Proton Pump Inhibitors (PPI), with high efficacy and low toxicity, are the most commonly prescribed and most frequently consumed medication globally. Because of their strong inhibitory effects on gastric acid secretion, they are the most potent first‐line therapy for whole range of gastric acid-related disorders, notably Gastroesophageal Reflux Disease (GERD). 

Methods 

The objective of this narrative review is to discuss the relatedness between long term use of PPI and associated adverse events. 

Results 

Whereas the FDA believes that there is very little risk of serious consequences when OTC PPI are used according to the directions on the OTC label (only intended for a 14-day course of treatment up to 3 times per year), any deviation from the set protocol certainly poses risks. However, in some circumstances, PPI needs to be continued indefinitely. Some recent studies, on long term use of PPI, have revealed potential adverse effects, including risks of hypomagnesemia, osteoporotic fractures, pneumonia, Clostridium difficile infection, dementia, acute and chronic kidney disease, rebound acid hypersecretion syndrome, vitamin B12 deficiency and iron deficiency.

Conclusion

As long as PPI are prescribed appropriately for those who genuinely require them for long term, the benefits greatly outweigh the risks. However, for continuation or maintenance therapy, the fitting approach would be administering the lowest effective dose with monitoring to determine the desired effectiveness, need to dose adjustment and possibility to consider discontinuation. 

Keywords: proton pump inhibitors, gastroesophageal reflux disease, inappropriate use, long term use, deprescribing

Introduction 

“There are three side effects of acid: enhanced long-term memory, decreased short-term memory, and I forget the third”. Timothy Leary (1920-1996)— American Psychologist

 The pivotal role of gastric acid in normal upper gastrointestinal functioning including digestion, absorption of micronutrients and some protective effects against bacterial infections has been well described in medical literature for centuries. However, inappropriate gastric acid secretions certainly pose pathological conditions of varying intensity. Gastroesophageal Reflux Disease (GERD) is a chronic, relapsing malady carrying a risk of significant morbidity and potential mortality from resultant complications.

 Although American Gastroenterologist AsherWinkelstein, in 1934, was the first to define clinically “Reflux oesophagitis” at 85th Session of American Medical Association, it had appeared among patients earlier than that time.1 In 1025, Persian physician Ibn Sina (980–1037) in his Magnum Opus “Canon of Medicine” had described dyspeptic symptoms fitting the picture of GERD.He also mentioned “Gastric headache”, associated with reflux symptoms.2 

GERD has been defined, by World Gastroenterology Organization (WGO), as “troublesome symptoms sufficient to impair an individual’s quality of life, or injury or complications that result from the retrograde flow of gastric contents into the esophagus, oropharynx, and/or respiratory tract. Reflux-induced symptoms, erosive esophagitis, and long-term complications may have severely deleterious effects on daily activities, work productivity, sleep, and quality of life”.3 

The wondrous Proton Pump Inhibitors (PPI), because of their profound and consistent inhibitory effects on gastric acid secretion, remain the mainstay of treatment of GERD. 4 The objective of this narrative review is to discuss the relatedness between long term use of PPI and associated adverse events