Dr Inder Mainie Gastroenterology March 2021 OGcancerNI PPIs Omeprazole Lansoprazole Esomeprazole Pantoprazole Rabeprazole Indications Proton pump inhibitors PPIs block the gastric HKATPase inhibiting gastric acid secretion ID: 933435
Download Presentation The PPT/PDF document "Proton Pump Inhibitors and concerns" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Proton Pump Inhibitors and concerns
Dr Inder Mainie
Gastroenterology
March 2021
OGcancerNI
Slide2PPIs
Omeprazole
Lansoprazole
Esomeprazole
Pantoprazole
Rabeprazole
Slide3Slide4Indications
Proton pump inhibitors (PPIs) block the gastric H,K-ATPase, inhibiting gastric acid secretion.
Healing
of peptic
ulcers
Gastroesophageal
reflux disease (
GORD)
Barrett's oesophagus
Zollinger
-Ellison syndrome
E
radication
of Helicobacter pylori as part of combination regimens.
Slide5When do I use PPIs for GORD?
Mild/intermittent –antacids, H2RA as required
Moderate – 8 weeks of H2RA or PPI – testing if no response
Severe symptoms -8 weeks of daily PPI (increased to BD if some response)
Always use to lowest effective dose to control symptoms
Overuse of PPIs
Slide6Side-effects
The common adverse effects include: nausea, diarrhoea, abdominal pain, fatigue, and dizziness
Slide7Long-term Side effects
Infections
Gastric Cancer
Kidney Disease
Dementia
Impaired absorption of micronutrients
Bone Fractures
L
iver
disease
Slide8PPIs –Rivaroxaban or Apsirin
COMPASS trial
17,598 Patients > 65 years with cardiac and PVD (placebo trial)
Outcomes –no difference in MI, stroke or cardiac mortality
No difference in Pneumonia, fractures, chronic kidney disease, dementia, cancer, gastric atrophy
Slight increase in enteric infections –diarrhoea
Slight increase in C diff (PPI group)but not significant
Moayyedi
P, Gastro 2019
Slide9PPIs and Clopidogrel
No interaction –Cogent trial
Slide10PPI and oesophageal cancer
Probably helps – Aspect trial
Slide11PPIs and diarrhoea
Gastric acid kill bacteria
PPIs affect the gut microbiome
Less acid to kill bacteria
Risk of bacterial gastroenteritis-(salmonella and campylobacter)-
with PPI
use moderate association with moderate evidence C Difficile – risk with PPI –weak association
Risk is higher with antibiotic and PPI
Moderate amount of evidence
Slide12PPIs and Kidney disease
Rare
Moderate association
12 cases in 100,000 pts
Stop it and risk goes down
Slide13PPIs and Bone fractures
PPIs reduce calcium absorption –osteoporosis
Studies –not consistent
Slide14Slide15PPIs and Pneumonia
5 recent studies
Seen in one study but not in the other four
Weak and not consistent
Slide16Most studies are observational
Slide17Slide18Slide19PPIs and Covid 19
One-line study nearly 54,000
particiants
South
korea
study -? Weak
? Slight increase but need more studies
Slide20Lifestyle for GORD
Keep a healthy weight
Reduce
caffeine (coffee and tea) and chocolates
Reduce
alcohol
Reduce citrus drinks
Reduce tomato-based products
Reduce carbonated beverages
Reduce peppermint
Reduce fatty or spicy foods
Reduce smoking
Eating smaller meals
Don’t eat within three hours of bedtime
Raising the head of their bed by 4–8 inches (10–20 cm)
Reduce stress levels
Slide21When do I take them?
Ideally 30
mins
before
meals
Long-term PPI therapy - administered in the lowest effective dose, including on demand or intermittent therapy
.
PPIs are safe in pregnant patients (if clinically
indicated)
In
patients with partial response to PPI therapy, increasing the dose to twice daily therapy or switching to a different PPI may provide additional symptom relief