The American Gastroenterological Association (AGA) has determined, however, that as long as they are appropriately prescribed, the benefits of PPIs generally outweigh their risks. That was the conclusion in a new clinical practice update published in Gastroenterology.
Still, the Columbia University Medical Center–led authors point out that evidence is currently insufficient to recommend specific techniques to avoid or resolve adverse effects linked to PPIs.
Background information in the report notes that long-term use of PPIs by patients— for gastroesophageal reflux disease (GERD), Barrett’s esophagus, and nonsteroidal anti-inflammatory drug (NSAID) bleeding prophylaxis—increased twofold in the United States over a 3-year period ending in 2012. At the same time, the report notes, adverse events also doubled.
To help clinicians navigate the situation, the AGA made the following recommendations:
• PPIs should be prescribed short-term for GERD and acid-related complications, with a goal of healing and symptom control.
• While patients with uncomplicated GERD who respond well to short-term PPIs should seek to reduce or discontinue them, those who can’t should be considered for ambulatory esophageal pH/impedance monitoring before being prescribed lifelong PPIs to determine whether the real problem is a functional syndrome or GERD.
• Long-term PPIs should continue to be prescribed for patients with Barrett’s esophagus, possibly even if asymptomatic, as well as for symptomatic GERD.
• If patients are at high risk for ulcer-related bleeding from NSAIDs, they should take a PPI.
• Long-term PPI dosages should be routinely reevaluated so that the lowest effective PPI dose can be prescribed to manage conditions.
• Long-term PPI users should not routinely use probiotics to prevent infection or to raise their intake of calcium, vitamin B12, or magnesium beyond the recommended dietary allowance.
• Bone mineral density, serum creatinine, magnesium, and vitamin B12 do not need to be routinely screened or monitored in long-term PPI users.
The update authors did not recommend specific PPI formulations based on potential risks.
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