Proton pump inhibitor therapy predisposes to community‐acquired <i><scp>S</scp>treptococcus pneumoniae</i> pneumonia

Jager, Cornelis P.C. de; Wever, Peter C.; Gemen, Eugenie F.A.; Oijen, Martijn G.H. van; Gageldonk-Lafeber, Arianne B van; Siersema, Peter D.; Kusters, G.C.M.; Laheij, R.J.F.

doi:10.1111/apt.12069

Cited by 73 publications

(48 citation statements)

References 37 publications

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“…Gastric acid plays an important role in killing ingested bacteria, and some reports allege that acid suppression with PPIs might increase the risk of enteric infections [27], pneumonias [28], Clostridium difficile colitis [29], small intestinal bacterial overgrowth [30], and spontaneous bacterial peritonitis in patients with cirrhosis [31]. PPIs have been shown to interfere with the absorption of vitamin B 12 and to cause hypomagnesemia, and PPI effects on magnesium and calcium metabolism might increase the risk for bone fractures [32,33].…”

Section: Ppi Side Effectsmentioning

confidence: 99%

Does Barrett's Esophagus Regress after Surgery (or Proton Pump Inhibitors)

Spechler

2014

Dig Dis

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Barrett's esophagus, the condition in which metaplastic columnar epithelium that predisposes to cancer development replaces the squamous epithelium that normally lines the distal esophagus, is a complication of gastroesophageal reflux disease (GERD). Metaplasia is a potentially reversible condition, and partial regression of Barrett's metaplasia has been documented with effective medical or surgical therapy for GERD. The important issue for patient management is not whether antireflux treatment causes Barrett's esophagus to regress, but rather whether antireflux therapy prevents cancer in Barrett's esophagus. Proton pump inhibitors (PPIs) would be expected to prevent this cancer because they heal reflux esophagitis, reduce exposure to a potential carcinogen (acid), and might prevent acid-induced proliferation and cancer-promoting cytokine secretion by esophageal epithelial cells. Furthermore, observational studies have shown that PPI use is associated with a decreased incidence of neoplasia in Barrett's esophagus. In theory, successful antireflux surgery, which eliminates the reflux of both acid and bile, should be better for cancer prevention than medical therapy, which only decreases the reflux of acid. However, high-quality studies show no significant difference in cancer incidence between medically and surgically treated patients with GERD and Barrett's esophagus. Furthermore, for individual patients with nondysplastic Barrett's metaplasia, the cancer risk is so small and the number needed to treat for cancer prevention with surgery so large, that it does not matter whether or not surgery provides a tiny margin of extra protection against cancer beyond that provided by medical therapy. The cost and risks of the operation overwhelm any small, additional cancer protective benefit. Antireflux surgery is very effective at controlling the endoscopic signs and symptoms of GERD, but the operation should not be recommended to patients solely with the rationale that it protects against cancer better than medical therapy.

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Section: Ppi Side Effectsmentioning

confidence: 99%

Does Barrett's Esophagus Regress after Surgery (or Proton Pump Inhibitors)

Spechler

2014

Dig Dis

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“…Koeficijent korelacije za IPP i pneumoniju iznosio je 2,8, a za AH 2 R znatno manje svega 1,6 [22]. Slične rezultate objavljuju autori kohort studije, koja je obuhvatila 463 bolesnika sa nozokomijalnom pneumonijom, od kojih je njih 29% primalo IPP, a najčešći uzročnik bio je Streptococcus pneumoniae [23]. Ipak, ima i onih koji tvrde da je rizik od razvoja hospitalne pneumonije identičan kod obe grupe antisekretornih lekova, i IPP i AH 2 R, ali da su na značajno većem riziku stariji bolesnici (> 65 godina starosti) [24].…”

Section: Potencijalni Rizici Primene Inhibitora Protonske Pumpeunclassified

Inhibitori protonske pumpe – primena i bezbednost

Rašić

Hudomal

et al. 2013

Biomedicinska istraž.

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Kratak sadržajUvod. Inhibitori protonske pumpe (IPP) primenjuju se u terapiji acido peptičkih poremećaja uključujući peptički ulkus, gastroezofagusni reflex, erozivni i neerozivni ezofagitis, Zollinger-Elissonov sindrom, Helicobacter pylori infekcije i profilaksu stres ulkusa. Dobro dokumentovana efikasnost i relativna bezbednost primene, doprineli su značajnom propisivanju IPP u praksi. Neželjena dejstva IPP nisu ozbiljna i javljaju se kod približno 1-3% lečenih pacijenata, bez značajnijih razlika među pojedinačnim predstavnicima. Dugotrajna terapija IPP povećava rizik od razvoja rebound hipersekrecije želudačne kiseline, pneumonije i enteralnih bakterijskih infekcija (dijareja izazvana sa Clostridium difficile), preloma kostiju i kardiovaskularni rizik pri istovremenoj primeni sa klopidogrelom. IPP ne izazivaju deficit gvožđa i vitamina B12, ali povećavaju rizik od razvoja hipomagnezemije. Većina iznetih podataka potiče iz retospektivnih kohort i case-control studija. Da bi se utvrdila tačna uzročno posledična povezanost između IPP i neželjenih događaja neophodno je sprovesti velika prospektivna, randomizirana, kontrolisana klinička ispitivanja. Mnogo racionalnija upotreba IPP smanjila bi troškove u zdravstvu i osigurala njihovu bezbedniju primenu.Ključne reči: inhibitori protonske pumpe, dugotrajna primena, neželjena dejstva UvodInhibitori protonske pumpe (IPP) predstavljaju najefikasniju grupu antisekretornih lekova, koji su za samo nekoliko godina postali lekovi prvog izbora za sva stanja koja su praćena hiperaciditetom tj. pojačanim lučenjem želudačne kiseline. Tako su glavne indikacije za njihovu primenu peptički ulkus, erozivni i neerozivni refluksni ezofagitis, Zollinger-Ellisonov sindrom, infekcija izazvana bakterijom Helicobacter pylori (u okviru kombinovane terapije), kao i profilaksa stres ulkusa. Derivat benzimidazola -omeprazol prvi je

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“…The risk was higher in patients with dementia and in those with sedative and tranquilizer usage [16•]. PPI use was more frequently associated with S. pneumoniae, with a twofold increased risk of CAP compared to nonusers [17].…”

Section: Cap and Other Diseasesmentioning

confidence: 99%

Management of community-acquired pneumonia

Ehsan¹,

Metersky

2013

Curr Respir Care Rep

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This article summarizes recent literature related to community-acquired pneumonia (CAP), which continues to represent one of the most common causes of morbidity and mortality throughout the world, especially in the elderly. The impact is even more striking if we take healthcare costs into account. Patients with CAP usually have other comorbidities which not only increase mortality in this group but also add further to its economic burden. Patients with COPD, preexisting cardiac disease, and diabetes are particularly at higher risk for developing more severe pneumonia. New diagnostic modalities, including ultrasonography, are being used more commonly in clinical practice. Procalcitonin levels can be used to identify bacterial pneumonia and to de-escalate antibiotic therapy, resulting in fewer days on antibiotics. Other biomarkers have been used in studies to stratify patients by risk. Guideline-concordant regimens including atypical coverage, and macrolides in particular, appear to provide benefit. More recent data suggest the need for careful screening of patients for cardiovascular risk factors prior to initiating macrolides and fluoroquinolones.

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Proton pump inhibitor therapy predisposes to community‐acquired Streptococcus pneumoniae pneumonia

Abstract: SUMMARY BackgroundThe pathophysiological mechanisms which contribute to an increased risk of community-acquired pneumonia (CAP) in patients using proton pump inhibitors are not well established.

Cited by 73 publications

References 37 publications

Does Barrett's Esophagus Regress after Surgery (or Proton Pump Inhibitors)

Does Barrett's Esophagus Regress after Surgery (or Proton Pump Inhibitors)

Inhibitori protonske pumpe – primena i bezbednost

Management of community-acquired pneumonia

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