Problems Associated with Deprescribing of Proton Pump Inhibitors
Proton pump inhibitors (PPIs) are recommended as a first-line treatment for gastroesophageal reflux disease (GERD) and other acid related disorders. In recent years, concerns have been raised about the increasing prevalence of patients on long-term PPI therapy and inappropriate PPI use. It is well k...
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doaj-b407dc91d3f74c4da4faba3e63502b562020-11-25T02:03:10ZengMDPI AGInternational Journal of Molecular Sciences1422-00672019-11-012021546910.3390/ijms20215469ijms20215469Problems Associated with Deprescribing of Proton Pump InhibitorsHolmfridur Helgadottir0Einar S. Bjornsson1Faculty of Medicine, University of Iceland, 101 Reykjavik, IcelandFaculty of Medicine, University of Iceland, 101 Reykjavik, IcelandProton pump inhibitors (PPIs) are recommended as a first-line treatment for gastroesophageal reflux disease (GERD) and other acid related disorders. In recent years, concerns have been raised about the increasing prevalence of patients on long-term PPI therapy and inappropriate PPI use. It is well known that short-term PPI therapy is generally well tolerated and safe; however, their extensive long-term use is a major global issue. One of these long-standing concerns is PPI-induced gastrin elevation secondary to hypoacidity. Hypergastrinemia is believed to play a role in rebound hyperacidity when PPIs are discontinued resulting in induced dyspeptic symptoms that might result in the reinstitution of therapy. Gastrin exerts tropic effects in the stomach, especially on enterochromaffin-like (ECL) cells, and concerns have also been raised regarding the potential progression to dysplasia or tumor formation following long-term therapy. It is well known that a substantial number of patients on long-term PPI therapy can discontinue PPIs without recurrence of symptoms in deprescribing trials. What is unknown is how sustainable deprescribing should be undertaken in practice and how effective it is in terms of reducing long-term outcomes like adverse drug events, morbidity and mortality. Moreover, there is no clear consensus on when and how deprescribing strategies should be attempted in practice. This review sought to summarize the harms and benefits of long-term PPI therapy with special focus on gastrin elevation and its relation to deprescribing studies and future interventions that may improve PPI use.https://www.mdpi.com/1422-0067/20/21/5469proton pump inhibitorsgastrinrebound acid hypersecretiondeprescribingstep-downtaperingon-demanddiscontinuation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Holmfridur Helgadottir Einar S. Bjornsson |
spellingShingle |
Holmfridur Helgadottir Einar S. Bjornsson Problems Associated with Deprescribing of Proton Pump Inhibitors International Journal of Molecular Sciences proton pump inhibitors gastrin rebound acid hypersecretion deprescribing step-down tapering on-demand discontinuation |
author_facet |
Holmfridur Helgadottir Einar S. Bjornsson |
author_sort |
Holmfridur Helgadottir |
title |
Problems Associated with Deprescribing of Proton Pump Inhibitors |
title_short |
Problems Associated with Deprescribing of Proton Pump Inhibitors |
title_full |
Problems Associated with Deprescribing of Proton Pump Inhibitors |
title_fullStr |
Problems Associated with Deprescribing of Proton Pump Inhibitors |
title_full_unstemmed |
Problems Associated with Deprescribing of Proton Pump Inhibitors |
title_sort |
problems associated with deprescribing of proton pump inhibitors |
publisher |
MDPI AG |
series |
International Journal of Molecular Sciences |
issn |
1422-0067 |
publishDate |
2019-11-01 |
description |
Proton pump inhibitors (PPIs) are recommended as a first-line treatment for gastroesophageal reflux disease (GERD) and other acid related disorders. In recent years, concerns have been raised about the increasing prevalence of patients on long-term PPI therapy and inappropriate PPI use. It is well known that short-term PPI therapy is generally well tolerated and safe; however, their extensive long-term use is a major global issue. One of these long-standing concerns is PPI-induced gastrin elevation secondary to hypoacidity. Hypergastrinemia is believed to play a role in rebound hyperacidity when PPIs are discontinued resulting in induced dyspeptic symptoms that might result in the reinstitution of therapy. Gastrin exerts tropic effects in the stomach, especially on enterochromaffin-like (ECL) cells, and concerns have also been raised regarding the potential progression to dysplasia or tumor formation following long-term therapy. It is well known that a substantial number of patients on long-term PPI therapy can discontinue PPIs without recurrence of symptoms in deprescribing trials. What is unknown is how sustainable deprescribing should be undertaken in practice and how effective it is in terms of reducing long-term outcomes like adverse drug events, morbidity and mortality. Moreover, there is no clear consensus on when and how deprescribing strategies should be attempted in practice. This review sought to summarize the harms and benefits of long-term PPI therapy with special focus on gastrin elevation and its relation to deprescribing studies and future interventions that may improve PPI use. |
topic |
proton pump inhibitors gastrin rebound acid hypersecretion deprescribing step-down tapering on-demand discontinuation |
url |
https://www.mdpi.com/1422-0067/20/21/5469 |
work_keys_str_mv |
AT holmfridurhelgadottir problemsassociatedwithdeprescribingofprotonpumpinhibitors AT einarsbjornsson problemsassociatedwithdeprescribingofprotonpumpinhibitors |
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