Long Term Acid Suppressant Medications (ppi聮s): Concerns and Care Health Articles | April 12 Cheap Kids MLB Jerseys , 2015
Maintenance antisecretory acid therapy (PPI’s) are used in many patients, particularly those with gastroesophageal reflux disease(GERD). With the long-term use of any medication, drug safety becomes an important issue. Acid (HCl) is normally secreted into the gastric lumen, where it serves to both digest dietary protein and maintain a sterile environment by removing ingested bacterias. Proton pump inhibitors (PPIs) are strong acid suppressants, and thus long term usage has raised several issues which shall be discussed in this article.
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Maintenance antisecretory acid therapy (PPI’s) are used in many patients Cheap Youth MLB Jerseys , particularly those with gastroesophageal reflux disease(GERD). With the long-term use of any medication, drug safety becomes an important issue. Acid (HCl) is normally secreted into the gastric lumen, where it serves to both digest dietary protein and maintain a sterile environment by removing ingested bacterias. Proton pump inhibitors (PPIs) are strong acid suppressants, and thus long term usage has raised several issues which shall be discussed in this article.
The three main concerns regarding the long-term usage of proton pump inhibitors (PPIs) include :
Risk of infectious complications – including Pneumonias, Cl difficile diarrhoeas
Malabsorption of Iron Cheap Womens MLB Jerseys , Vitamin B12, Magnesium and Metabolic bone disease
Hypergastrinemia, Gastric carcinoids and Atrophic Gastritis
Other concerns include acute interstitial nephritis (kidney disease) and drug interactions particularly reducing the effect of Clopidogrel, which is used in coronary stented patients to reduce the risk of stent blockage.
Infections A concern with any form of gastric acid inhibition is an increased risk of enteric infections since gastric acid normally protects against these infections. In addition, a reduction in gastric acid secretion permits bacteria to more easily colonize the upper gastrointestinal tract Cheap Mens MLB Jerseys , which may predispose to pneumonia.
Clostridium difficile and other enteric infections The best documented association of PPI use with enteric infections has been with C. difficile diarrhea, even in patients not exposed to antibiotics(1-7). C. difficile is an anaerobic organism that sporulates; acid-resistant spores are presumed to be the major vector of disease transmission. Three meta-analyses of observational studies have demonstrated an increased risk of C. difficile infections in patients treated with PPIs(8-10). A 2012 meta-analysis of 42 observational studies that included 313,000 patients found that PPI use was significantly associated with an increased risk of both incident and recurrent C. difficile infection(9).
The US Food and Drug Administration (FDA) has issued a safety alert encouraging providers to consider a diagnosis of C. difficile-associated disease in PPI users with persistent diarrhea(11). Given the potential risk of C. difficile infection, the FDA has also recommended that providers prescribe the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated.
Associations with other enteric infections, including Campylobacter and Salmonella Cheap MLB Jerseys Wholesale , have also been reported(12-15), but the risk is uncertain(16).
Pneumonia The risk of pneumonia in PPI users may be increased due to a reduction in gastric acid secretion, permitting bacteria to more easily colonize the upper gastrointestinal tract. The increased risk has been seen with both community-acquired pneumonia (CAP) and health care associated pneumonia (HCAP)(17-19). A meta-analysis of 31 studies found that patients taking PPIs or H2 receptor antagonists (H2RAs) were at increased risk for pneumonia(20).
Malabsorption Concern has been expressed regarding the effects of long-term PPI use on iron and vitamin B12 absorption, though any effects are generally mild, clinically insignificant Cheap MLB Jerseys Free Shipping , and addressed by supplement therapy(21). On the other hand, magnesium and calcium malabsorption may be bigger problems, predisposing to hypomagnesia and metabolic bone disease.
Magnesium absorption Hypomagnesemia due to reduced intestinal absorption has been described with PPI use(22). In March 2011, the FDA issued a safety alert warning providers of the risk of hypomagnesemia in patients who have been on PPIs long-term (generally longer than one year)(23).
Hip fracture and calcium malabsorption Long-term use of PPIs may influence bone metabolism. Hypochlorhydria could theoretically reduce calcium absorption(24) and inhibit osteoclastic activity(25,26) Cheap MLB Jerseys From China , thereby decreasing bone density. A case-control trial suggested that long-term use of PPIs was associated with a slightly increased risk of hip fractures in those older than 50 years of age and that the magnitude of the risk increase was proportional to both PPI dose and duration of therapy(27). A meta-analysis that included 11 cohort and case-control studies examined the risk of fractures associated with PPI use(28). The 11 studies included 1,084,560 patients with 62,210 PPI users, 71 Cheap MLB Jerseys China ,339 patients with hip fractures, 161,179 patients with any-site fractures, and 5728 patients with spine fractures. The risk of hip fracture was increased among PPI users compared with nonusers. There was also an increased risk of spine and any-site fracture. The FDA has mandated revised safety information on all PPIs about a possible increased risk of fractures of the hip, wrist Cheap MLB Jerseys , and spine with the use of these medications(29). The FDA also recommends that healthcare professionals who prescribe PPIs consider whether a lower dose or shorter duration of therapy would adequately treat the patient’s condition.
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