scholarly journals The Rate of Prescribing Gastrointestinal Prophylaxis with Either a Proton Pump Inhibitor Or an H2-Receptor Antagonist in Nova Scotia Seniors Starting Nonsteroidal Anti-Inflammatory Drug Therapy

2010 ◽  
Vol 24 (8) ◽  
pp. 481-488 ◽  
Author(s):  
Bogdan Superceanu ◽  
Sander Veldhuyzen van Zanten ◽  
Chris Skedgel ◽  
Michael Shepherd ◽  
Ingrid Sketris
Keyword(s):  
Nova Scotia ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Nonselective Nsaid ◽  
H2 Receptor Antagonist ◽  
Number Of Patients ◽  
Increased Risk ◽  
Gastroprotective Agent ◽  
Anti Inflammatory ◽  
One Year

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used agents that can cause serious gastrointestinal (GI) side effects. For patients at increased risk of NSAID-related GI complications, prophylaxis with either a nonselective NSAID plus gastroprotective agent (GPA) or, alternatively, therapy with a cyclooxygenase-2 selective inhibitor with or without a GPA such as a proton pump inhibitor (PPI), is recommended.AIM: To describe the rate, timing and duration of GI prophylaxis in Nova Scotia seniors receiving nonselective NSAIDs.METHODS: The Nova Scotia Seniors’ Pharmacare Program beneficiaries for the years 1998 to 2002 were studied. A cohort of incident NSAID and GPA users was selected from all nonselective NSAID users (no prescribed NSAID dispensed 12 months before the index month and no GPA dispensed two months before the index prescription). Monthly coprescribing rates were calculated by dividing the number of patients in the cohort using GPAs by the number of NSAID users. GI prophylactic coprescribing was defined as the coprescribing rate present at the first month (index month) of prescribing an NSAID.RESULTS: The cohort consisted of 12,906 patients. Seventy-five per cent of the nonselective NSAID prescriptions dispensed were for up to two months duration, with only 2.3% longer than one year. GI prophylaxis was given to only 3.8% of patients starting NSAIDs who were not on a GPA in the two months before starting NSAIDs. Of this 3.8%, 92.7% of the patients received H2-receptor antagonists (H2RAs), and 7% received PPIs. The rate of H2RA coprescribing increased with the number of consecutive months on an NSAID from 3.5% in the first month to 24.1% at 48 months. For PPIs, the coprescribing rate increased from 0.3% to 1.9% of all NSAID users in the cohort. The rate of gastroprophylaxis coprescribing for patients receiving NSAIDs did not rise with increasing age.CONCLUSION: In Nova Scotian seniors using nonselective NSAIDs, the rate of GI prophylaxis was low. Most patients received H2RAs as GPAs despite evidence that they offer insufficient protection.

scholarly journals Disappearance of Gastric Hyperplastic Polyps after the Discontinuation of Proton Pump Inhibitor in a Patient with Liver Cirrhosis

2021 ◽  
pp. 202-209
Author(s):  
Kengo Yasugi ◽  
Ken Haruma ◽  
Miwa Kawanaka ◽  
Mitsuhiko Suehiro ◽  
Jun Nakamura ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Upper Gastrointestinal Endoscopy ◽  
Complete Disappearance ◽  
Hyperplastic Polyps ◽  
Cell Hyperplasia ◽  
Greater Curvature ◽  
One Year ◽  
Epithelium Cells

Here, we report on a rare case of gastric hyperplastic polyps which disappeared after the discontinuation of proton pump inhibitor (PPI). The patient was an 83-year-old woman with liver cirrhosis and portal hypertension, along with gastroesophageal reflux disease treated by PPI. An initial upper gastrointestinal endoscopy showed unique polypoid lesions in the greater curvature of the stomach. Biopsy specimens of the lesions were diagnosed as hyperplastic polyps and she was followed. One year later, a second endoscopy showed that the lesions had increased in number and size, and an endoscopic mucosal resection (EMR) was performed for the main polyps. The resected specimens indicated a proliferation of foveolar epithelium cells with an increase of capillary ectasia and parietal cell hyperplasia, which was thought to be induced by hypergastrinemia from the PPI. Three months after the EMR, she was admitted because of bleeding from the remaining polyps along with an increase in new polyps. After conservative treatment, PPI was stopped and rebamipide was used. One year and 6 months later, an endoscopy showed the complete disappearance of all gastric polyps.

scholarly journals Evidence-Based Recommendations for Short- and Long-Term Management of Uninvestigated Dyspepsia in Primary Care: An Update of the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool

2005 ◽  
Vol 19 (5) ◽  
pp. 285-303 ◽  
Author(s):  
Sander JO Veldhuyzen van Zanten ◽  
Marc Bradette ◽  
Naoki Chiba ◽  
David Armstrong ◽  
Alan Barkun ◽  
...  
Keyword(s):  
Primary Care ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Clinical Management ◽  
Management Tool ◽  
Noninvasive Testing ◽  
Ulcer Bleeding ◽  
High Dose ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

The present paper is an update to and extension of the previous systematic review on the primary care management of patients with uninvestigated dyspepsia (UD). The original publication of the clinical management tool focused on the initial four- to eight-week assessment of UD. This update is based on new data from systematic reviews and clinical trials relevant to UD. There is now direct clinical evidence supporting a test-and-treat approach in patients with nondominant heartburn dyspepsia symptoms, and head-to-head comparisons show that use of a proton pump inhibitor is superior to the use of H2-receptor antagonists (H2RAs) in the initial treatment of Helicobacter pylori-negative dyspepsia patients. Cisapride is no longer available as a treatment option and evidence for other prokinetic agents is lacking. In patients with long-standing heartburn-dominant (ie, gastroesophageal reflux disease) and nonheartburn-dominant dyspepsia, a once-in-a-lifetime endoscopy is recommended. Endoscopy should also be considered in patients with new-onset dyspepsia that develops after the age of 50 years. Conventional nonsteroidal anti-inflammatory drugs, acetylsalicylic acid and cyclooxygenase-2-selective inhibitors can all cause dyspepsia. If their use cannot be discontinued, cotherapy with either a proton pump inhibitor, misoprostol or high-dose H2RAs is recommended, although the evidence is based on ulcer data and not dyspepsia data. In patients with nonheartburn-dominant dyspepsia, noninvasive testing for H pylori should be performed and treatment given if positive. When starting nonsteroidal anti-inflammatory drugs for a prolonged course, testing and treatment with H2RAs are advised if patients have a history of previous ulcers or ulcer bleeding.

scholarly journals Proton Pump Inhibitor Use, Hypergastrinemia, and Gastric Carcinoids—What Is the Relationship?

2020 ◽  
Vol 21 (2) ◽  
pp. 662 ◽  
Author(s):  
Denis M. McCarthy
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Chronic Atrophic Gastritis ◽  
The Body ◽  
True Incidence ◽  
Ecl Cells ◽  
Gastric Carcinoids ◽  
Organ Systems ◽  
Increased Risk ◽  
Young Subjects

Neuroendocrine tumors (NETs) throughout the body are the focus of much current interest. Most occur in the gastrointestinal tract and have shown a major increase in incidence over the past 30 years, roughly paralleling the world-wide increase in the use of proton pump inhibitor (PPI) drugs. The greatest rise has occurred in gastric carcinoids (g-NETs) arising from enterochromaffin-like (ECL) cells. These tumors are long known to occur in auto-immune chronic atrophic gastritis (CAG) and Zollinger-Ellison syndrome (ZES), with or without multiple endocrine neoplasia type-1 (MEN-1), but the incidences of these conditions do not appear to have increased over the same time period. Common to these disease states is persistent hypergastrinemia, generally accepted as causing g-NETs in CAG and ZES, and postulated as having similar tumorigenic effects in PPI users. In efforts to study the increase in their occurrence, g-NETs have been classified in a number of discussed ways into different grades that differ in their incidence and apparent pathogenesis. Based on a large amount of experimental data, tumorigenesis is mediated by gastrin’s effects on the CCK2R-receptor on ECL-cells that in turn leads to hyperplasia, dysplasia, and finally neoplasia. However, in all three conditions, the extent of response of ECL-cells to gastrin is modified by a number of genetic influences and other underlying risk factors, and by the duration of exposure to the hormonal influence. Data relating to trophic effects of hypergastrinemia due to PPI use in humans are reviewed and, in an attached Appendix A, all 11 reports of g-NETs that occurred in long-term PPI users in the absence of CAG or ZES are summarized. Mention of additional suspected cases reported elsewhere are also listed. Furthermore, the risk in humans may be affected by the presence of underlying conditions or genetic factors, including their PPI-metabolizer phenotype, with slow metabolizers likely at increased risk. Other problems in estimating the true incidence of g-NETs are discussed, relating to non-reporting of small tumors and failure of the Surveillance, Epidemiology, and End Results Program (SEER) and other databases, to capture small tumors or those not accorded a T1 rating. Overall, it appears likely that the true incidence of g-NETs may be seriously underestimated: the possibility that hypergastrinemia also affects tumorigenesis in additional gastrointestinal sites or in tumors in other organ systems is briefly examined. Overall, the risk of developing a g-NET appears greatest in patients who are more than 10 years on drug and on higher doses: those affected by chronic H. pylori gastritis and/or consequent gastric atrophy may also be at increased risk. While the overall risk of g-NETs induced by PPI therapy is undoubtedly low, it is real: this necessitates caution in using PPI therapy for long periods of time, particularly when initiated in young subjects.

scholarly journals 13 Amending Admission Protocol to Reduce Proton Pump Inhibitor-Induced Hyponatraemia on A Specialist Hip Fracture Unit

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
R Darnell ◽  
B Clements ◽  
E Reeve ◽  
N Singh
Keyword(s):  
Hip Fracture ◽  
Proton Pump Inhibitor ◽  
Elderly Patients ◽  
Proton Pump ◽  
Side Effect ◽  
Sodium Concentration ◽  
Improvement Project ◽  
Number Of Patients ◽  
Group A ◽  
Group B

Abstract Introduction Hyponatraemia is a common electrolyte disturbance amongst elderly patients. Defined as a sodium concentration below 135 mmol/L, the BNF cites hyponatraemia as a ‘rare’ side effect of Omeprazole, a common proton pump inhibitor (PPI). In elderly patients, hyponatraemia can have significant morbidity. On our Hip Fracture Unit (HFU) at St Helier Hospital, all patients are commenced on Omeprazole on admission. We conducted a quality improvement project to reduce the incidence of PPI-induced hyponatraemia by altering standard protocol from Omeprazole to Ranitidine. Methods Phase 1: Retrospective analysis identifying incidence of PPI-induced hyponatraemia, defined as sodium concentration below 133mmol/L on two consecutive readings and resolving on switching to Ranitidine (Group A: n=86). Phase 2: Identifying incidence of hyponatraemia following administration of Ranitidine from admission (Group B: n=62). Exclusion criteria: Patients already on gastric protection or hyponatraemic on presentation. Chi squared analysis to establish statistical significance for risk of hyponatraemia associated with omeprazole. Results Total number of patients was 148. Age range 60-101 years (median 82 years). Incidence of PPI-induced hyponatraemia in Group A was 10.5% (9 cases). All resolved on switching to ranitidine. Following change in admission protocol to Ranitidine (Group B), incidence of hyponatraemia was 1.6% (1 case). The chance of developing hyponatraemia with Omeprazole was significantly higher than with ranitidine (P=0.0454). Conclusions 10.5% of admissions to the HFU experienced PPI-induced hyponatraemia. The European Medicines Agency defines side effects occurring at greater than 10% as very common. Whilst 45% of patients were on medication associated with hyponatraemia on admission, the absence of hyponatraemia at presentation and biochemical response when switching to ranitidine, demonstrates this is a significant side effect of PPIs. Given the increased morbidity associated with hyponatraemia, particularly in frail, elderly patients, amending protocol to ranitidine for gastric protection has the potential to reduce harm and improve patient outcomes.

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