Potential adverse effects of proton pump inhibitors

Abstract

Proton pump inhibitors (PPIs) have revolutionized the management of gastroesophageal reflux disease and peptic ulcer disease over the past two decades. Among the most commonly prescribed agents worldwide, PPIs' overall safety profile is unquestionable. However, emerging evidence indicates that PPI therapy, particularly with long-term and/or high-dose administration, is associated with several potential adverse effects, including enteric infections (eg, Clostridium difficile), community-acquired pneumonia, and hip fracture, all of which have received much attention recently. We review the current data on these and other potential consequences of PPI therapy. More judicious use of PPIs (eg, administering them in no more than the minimum effective dose to older adult patients) may help to further limit the impact of some of these possible adverse effects.

Proton pump inhibitor-associated pneumonia: Not a breath of fresh air after all?

“…Gastric acid is an important barrier to colonization and infections by invading pathogens [31,32] . There may be an increased incidence of Clostridium difficile infections with PPI administration [12] . Studies suggest that the administration of PPIs doubled the incidence of Clostridium difficile infections [11,[33][34][35] .…”

“…Although proton pump inhibitors (PPIs) are generally well-tolerated and clearly the most effective available agents used in the treatment of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), Helicobacter Pylori infections and other hypersecretory conditions, their use does not come without risks. For example, long term use of PPIs has been associated with increased risk of hip fractures [7][8][9][10] , Clostridium difficile infections [11,12] and, as is the focus of this paper, pneumonia. However, before engaging in a discussion on the potential risk of pneumonia associated with PPI exposure based on the current literature, this review first provides some relevant background on the basic pharmacology of PPIs.…”

Preventive and therapeutic strategies of pharmaco-correction gastropathy induced by nonsteroidal anti-inflammatory drugs

“…[1,24]. Кроме того, в цитоплазме многих клеток человеческого организ-ма локализуется близкий по биохимическому строе-нию фермент -вакуолярная Н + -АТФаза, активность которой в той или иной степени может быть пода-влена при использовании ИПП [8].…”

Proton Pump Inhibitor Prescription in Patients with Liver Cirrhosis: Indications in Theory and the Real World

“…Actually, evidences are accumulating on a range of possible side effects of PPIs [12][13][14][15][16][17][18][19][20][21][22][23][24][25] that vary from syndromes of malabsorption causing deficiencies -for example of iron, magnesium or copper [26], to osteoporosis or susceptibility to infections of the gastrointestinal tract or the respiratory system. Regarding the predisposition to infections, various are the hypotheses advanced to explain such susceptibility: by one side, the reduction of the dampening effect of gastric acid on the pathogenic intestinal flora and the consequent variations in the composition of the intestinal micro biota, and on the other maybe some direct effect on the modulation of the immune response, due to functional interference on the cells responsible for the innate immunity [27][28][29].…”