Proton pump inhibitors

Potential adverse effects

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: This review summarizes adverse effects of potential proton pump inhibitors (PPIs), including nutritional deficiencies (B12 and magnesium), rebound acid hypersecretion, acute interstitial nephritis, gastric carcinoid tumor, cardiovascular risk with clopidogrel and PPI coprescription, bone fractures, enteric infections and pneumonia. An epidemiologic framework is applied to assess clinical relevance and reinforce best practice recommendations. RECENT FINDINGS: The evidence for PPI adverse events is limited by the absence of Level 1 (randomized controlled trial) studies. The best evidence supports Clostridium difficile and bone fractures in susceptible populations. A substantial reduction in gastrointestinal bleeding risk without increase in cardiovascular events was observed in the COGENT trial when clopidogrel was coprescribed with omeprazole. The risk of pneumonia is inconsistent, and although acute interstitial nephritis, nutritional deficiencies (including B12 and hypomagnesemia), gastric carcinoid and rebound hyperacidity are biologically plausible, studies have failed to demonstrate supportive clinical relevance. SUMMARY: Prescribe PPI for robust indications only. Strong data supporting risk of adverse events are lacking; however, exercise caution in the elderly and in patients with other risk factors for bone fractures or C. difficile infection.

Original languageEnglish (US)
Pages (from-to)615-620
Number of pages6
JournalCurrent Opinion in Gastroenterology
Volume28
Issue number6
DOIs
StatePublished - Nov 2012
Externally publishedYes

Fingerprint

Proton Pump Inhibitors
clopidogrel
Bone Fractures
Interstitial Nephritis
Clostridium difficile
Carcinoid Tumor
Malnutrition
Pneumonia
Stomach
Clostridium Infections
Omeprazole
Practice Guidelines
Magnesium
Randomized Controlled Trials
Exercise
Hemorrhage
Acids
Infection
Population

Keywords

  • B12 deficiency
  • bone fractures
  • Clostridium difficile
  • hypomagnesemia
  • pneumonia
  • proton pump inhibitor side effects

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Proton pump inhibitors : Potential adverse effects. / Abraham, Neena Susan.

In: Current Opinion in Gastroenterology, Vol. 28, No. 6, 11.2012, p. 615-620.

Research output: Contribution to journalArticle

@article{4f28e1e3e88e4583807ce2acd9aebf60,
title = "Proton pump inhibitors: Potential adverse effects",
abstract = "PURPOSE OF REVIEW: This review summarizes adverse effects of potential proton pump inhibitors (PPIs), including nutritional deficiencies (B12 and magnesium), rebound acid hypersecretion, acute interstitial nephritis, gastric carcinoid tumor, cardiovascular risk with clopidogrel and PPI coprescription, bone fractures, enteric infections and pneumonia. An epidemiologic framework is applied to assess clinical relevance and reinforce best practice recommendations. RECENT FINDINGS: The evidence for PPI adverse events is limited by the absence of Level 1 (randomized controlled trial) studies. The best evidence supports Clostridium difficile and bone fractures in susceptible populations. A substantial reduction in gastrointestinal bleeding risk without increase in cardiovascular events was observed in the COGENT trial when clopidogrel was coprescribed with omeprazole. The risk of pneumonia is inconsistent, and although acute interstitial nephritis, nutritional deficiencies (including B12 and hypomagnesemia), gastric carcinoid and rebound hyperacidity are biologically plausible, studies have failed to demonstrate supportive clinical relevance. SUMMARY: Prescribe PPI for robust indications only. Strong data supporting risk of adverse events are lacking; however, exercise caution in the elderly and in patients with other risk factors for bone fractures or C. difficile infection.",
keywords = "B12 deficiency, bone fractures, Clostridium difficile, hypomagnesemia, pneumonia, proton pump inhibitor side effects",
author = "Abraham, {Neena Susan}",
year = "2012",
month = "11",
doi = "10.1097/MOG.0b013e328358d5b9",
language = "English (US)",
volume = "28",
pages = "615--620",
journal = "Current Opinion in Gastroenterology",
issn = "0267-1379",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Proton pump inhibitors

T2 - Potential adverse effects

AU - Abraham, Neena Susan

PY - 2012/11

Y1 - 2012/11

N2 - PURPOSE OF REVIEW: This review summarizes adverse effects of potential proton pump inhibitors (PPIs), including nutritional deficiencies (B12 and magnesium), rebound acid hypersecretion, acute interstitial nephritis, gastric carcinoid tumor, cardiovascular risk with clopidogrel and PPI coprescription, bone fractures, enteric infections and pneumonia. An epidemiologic framework is applied to assess clinical relevance and reinforce best practice recommendations. RECENT FINDINGS: The evidence for PPI adverse events is limited by the absence of Level 1 (randomized controlled trial) studies. The best evidence supports Clostridium difficile and bone fractures in susceptible populations. A substantial reduction in gastrointestinal bleeding risk without increase in cardiovascular events was observed in the COGENT trial when clopidogrel was coprescribed with omeprazole. The risk of pneumonia is inconsistent, and although acute interstitial nephritis, nutritional deficiencies (including B12 and hypomagnesemia), gastric carcinoid and rebound hyperacidity are biologically plausible, studies have failed to demonstrate supportive clinical relevance. SUMMARY: Prescribe PPI for robust indications only. Strong data supporting risk of adverse events are lacking; however, exercise caution in the elderly and in patients with other risk factors for bone fractures or C. difficile infection.

AB - PURPOSE OF REVIEW: This review summarizes adverse effects of potential proton pump inhibitors (PPIs), including nutritional deficiencies (B12 and magnesium), rebound acid hypersecretion, acute interstitial nephritis, gastric carcinoid tumor, cardiovascular risk with clopidogrel and PPI coprescription, bone fractures, enteric infections and pneumonia. An epidemiologic framework is applied to assess clinical relevance and reinforce best practice recommendations. RECENT FINDINGS: The evidence for PPI adverse events is limited by the absence of Level 1 (randomized controlled trial) studies. The best evidence supports Clostridium difficile and bone fractures in susceptible populations. A substantial reduction in gastrointestinal bleeding risk without increase in cardiovascular events was observed in the COGENT trial when clopidogrel was coprescribed with omeprazole. The risk of pneumonia is inconsistent, and although acute interstitial nephritis, nutritional deficiencies (including B12 and hypomagnesemia), gastric carcinoid and rebound hyperacidity are biologically plausible, studies have failed to demonstrate supportive clinical relevance. SUMMARY: Prescribe PPI for robust indications only. Strong data supporting risk of adverse events are lacking; however, exercise caution in the elderly and in patients with other risk factors for bone fractures or C. difficile infection.

KW - B12 deficiency

KW - bone fractures

KW - Clostridium difficile

KW - hypomagnesemia

KW - pneumonia

KW - proton pump inhibitor side effects

UR - http://www.scopus.com/inward/record.url?scp=84868369288&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84868369288&partnerID=8YFLogxK

U2 - 10.1097/MOG.0b013e328358d5b9

DO - 10.1097/MOG.0b013e328358d5b9

M3 - Article

VL - 28

SP - 615

EP - 620

JO - Current Opinion in Gastroenterology

JF - Current Opinion in Gastroenterology

SN - 0267-1379

IS - 6

ER -