Sunday, October 18, 2009
Good News for Proton Pump Inhibitors (PPI)
Proton Pump Inhibitor drugs (PPIs) have been used since the 1980s to reduce gastric acid secretion and to treat ulcers and reflux. They are now among the most widely prescribed drugs world wide and Prilosec and others can be obtained over- the- counter. Any time drugs are used long term, we should be re-evaluating their safety. The good news for PPIs, is that they are safe for chronic use.
PPIs do their work on the parietal cells of the stomach. They bind at the "proton pump" and prevent secretion of acid into the stomach. The effect is prolonged (24-48 hours) and the drug is cleared by the liver with very little effect on the kidneys.
The side effects are few so these medications (Prilosec, Aciphex, Prevacid, Protonics) are often prescribed to hospitalized patients and for patients with GERD, gastritis and ulcers. Patients take these medications for years and there have been numerous studies that looked at potential long-term effects of PPI use.
The studies have shown that PPIs are highly effective drugs and they have revolutionized the management of acid-related disorders during the last 2 decades. When was the last time you heard of someone getting surgery for "ulcers"? That was a common treatment just 30 years ago.
Studies that looked at PPIs and their effect on Vit B12 absorption, iron loss, colon cancer, gastric cancer and calcium deficiency found no definite link. There may be an association in hospitalized patients who are on PPIs and the incidence of Clostridium difficile infection. No association was seen in non-hospitalized patients.
As with all medications, PPIs should be used for appropriate indications only as long as needed. If you or a friend have been taking PPIs for a long time, you may wish to talk with your doctor about a "drug holiday" to see if it is still needed. I review chronic medications with my patients at least every year with the goal of eliminating any that are not absolutely needed.
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