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Proton Pump Inhibitors: What the Internist Needs to Know
1Division of Gastroenterology, Center for Esophageal Diseases, Baylor University Medical Center, Center for Esophageal Research, Baylor Scott & White Research Institute, 3500 Gaston Avenue, 2 Hoblitzelle, Suite 250, Dallas, TX 75246, USA.
The Medical Clinics of North America
|November 24, 2018
Summary
Proton pump inhibitors (PPIs) manage gastric acid but may have non-acid-related effects. Physicians should carefully consider PPI indications due to frequent inappropriate prescribing and uncertain risks.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Proton pump inhibitors (PPIs) are widely used for gastric acid suppression.
- Emerging evidence suggests PPIs may possess anti-inflammatory properties independent of acid suppression.
Purpose of the Study:
- To review the physiology of gastric acid suppression by PPIs.
- To examine PPIs' anti-inflammatory effects beyond acid suppression.
- To discuss valid indications and putative adverse effects of PPIs.
Main Methods:
- Literature review of physiological and pharmacological effects of PPIs.
- Analysis of observational studies on PPI-associated adverse events.
- Evaluation of evidence strength for PPI indications and risks.
Main Results:
- PPIs effectively suppress gastric acid.
- PPIs exhibit anti-inflammatory effects not directly linked to acid suppression.
- Many PPIs are prescribed inappropriately, and evidence for adverse effects is often weak but not dismissible.
Conclusions:
- Physicians must carefully evaluate the necessity of PPI therapy.
- The potential risks of PPIs warrant consideration despite weak supporting evidence.
- Appropriate prescribing of PPIs is crucial for patient care.
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