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

Durham University, Durham, England, United Kingdom
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.73). 09/2005; 22 Suppl 1(s1):55-63. DOI: 10.1111/j.1365-2036.2005.02611.x
Source: PubMed


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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    • "Equally interestingly, it is a first-in-class proton pump inhibitor and one of the most commonly prescribed drugs internationally. In a number of countries OME is available as an over the counter drug and is used by millions of people with more than 720 million prescriptions issued within 15 years from the year of approval (Kaunitz, 2014; Raghunath et al., 2005; Shaheen et al., 2006). Given the roles of P450s in the synthesis of epoxy-fatty acids, their induction by OME could have functional consequences. "
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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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    • "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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