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Review article: The long-term use of proton-pump inhibitors

Centre for Integrated Health Care Research, Wolfson Research Institute, University of Durham, Stockton-on-Tees, UK.
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.48). 09/2005; 22 Suppl 1(s1):55-63. DOI: 10.1111/j.1365-2036.2005.02611.x
Source: PubMed

ABSTRACT More than 15 years after the launch of omeprazole in 1988, proton-pump inhibitors remain central to the management of acid-suppression disorders and are unchallenged with regard to their efficacy and popularity among doctors and patients. They are considered safe despite early concerns about the possibility of an association with cancer and gastric atrophy; current concerns about long-term proton-pump inhibitor therapy are centred mainly on a possible association with fundic gland polyps and between Helicobacter pylori and gastric atrophic changes. Long-term proton-pump inhibitor usage accounts for the majority of the total proton-pump inhibitor usage. Long-term usage is difficult to define and most patients take proton-pump inhibitors non-continuously. Data indicate that a substantial proportion of long-term users do not have a clear indication for their therapy and there is thus room for reduction or rationalization of treatment. Overall, on-demand therapy is more cost-effective than continuous therapy and should be considered wherever possible.

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Available from: C. A. O’Morain, Oct 01, 2014
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    • "Older studies described gastric hyperplastic polyps as the most common type of gastric polyps, a more recent US study found fundic gland polyps to be the most common type of benign gastric polyp [12]. Fundic gland polyps are particularly common in patients with GERD and appear related to long-term suppression of gastric acid secretion with proton pump inhibitors [25] [26]. Their presence is inversely associated with the presence of gastric H. pylori infection, as demonstrated by the present analysis, as well as previously published data [27]. "
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    ABSTRACT: The aim of the study was to utilize a large national histopathology database for the analysis of the clinical epidemiology of gastric polyps. In a case-control study, 71,575 case subjects with gastric polyps were compared to 741,351 control subjects without gastric polyps. Of all patients, 7.72% harboured fundic gland polyps, 1.79% gastric hyperplastic polyps, 0.09% gastric adenomas, and 0.06% type I neuroendocrine tumours. All types showed a clear-cut age-dependent rise. Reflux disease was significantly more common in patients with fundic gland polyps and significantly less common in patients with gastric adenomas or neuroendocrine tumours. Anaemia was more common in patients with gastric hyperplastic polyps, gastric adenomas, or neuroendocrine tumours. Helicobacter pylori was found significantly less frequently in all subjects with gastric polyps than in controls. Intestinal metaplasia and gastric atrophy were both more common in gastric adenoma and neuroendocrine tumours and less common in fundic gland polyps than in controls. Different polyp types tended to coincide in the same patients. Gastric hyperplastic polyps appeared to mark the beginning of a progression from chronic gastritis to intestinal metaplasia and gastric atrophy, which leads to diminished gastric acid output and increased gastrin secretion. Gastric adenoma and neuroendocrine tumours reflect later stages of this process. Copyright © 2014. Published by Elsevier Ltd.
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    • "As a result, a large proportion of patients currently prescribed PPI do not have acid-related symptoms and thus, have no true indication for such therapy. Some studies also showed that up to 33% of patients who initiate PPI treatment redeem repeated prescriptions without any obvious indication for maintenance therapy [212] [226]. This empirical behavior may complicate PPI discontinuation, due to the development of rebound acid hypersecretion, leading to the relapse of the symptoms of the underlying acid-related disease (heartburn, acid regurgitation and dyspepsia) that might result in resumption of therapy [204] [205]. "
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    • "Studies have shown that most of the patients do not require prolonged PPI therapy and thus there is always need to rationalise their treatment. On demand therapy has been shown to be cost effective and should be considered in most patients [9]. "
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