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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Main Authors: Holmfridur Helgadottir, Einar S. Bjornsson
Format: Article
Language:English
Published: MDPI AG 2019-11-01
Series:International Journal of Molecular Sciences
Subjects:
Online Access:https://www.mdpi.com/1422-0067/20/21/5469
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spelling 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
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