Implementation of Proton Pump Inhibitor Deprescription Protocol in Geriatric Residents

2018 ◽  
Vol 52 (8) ◽  
pp. 747-753 ◽  
Author(s):  
Ovadyah Avraham ◽  
Michael Biglow
Keyword(s):  
Pilot Study ◽  
Proton Pump Inhibitor ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Histamine Receptor ◽  
Patient Specific ◽  
Pilot Design ◽  
Clinically Meaningful Outcomes ◽  
Geriatric Residents ◽  
Present Pilot Study

Background: Deprescribing is a recommended intervention to reduce morbidity and mortality caused by polypharmacy in older residents. However, a lack of definite deprescription guidelines and evidence of clinically meaningful outcomes complicates or precludes the practicality of such an approach. Objective: The objective of the present pilot study is to establish and implement a stepwise taper protocol that can potentially minimize overuse of proton pump inhibitors in a safe, effective, and feasible manner in the nursing home. Methods: Proton pump inhibitor dosage was reduced by half every 3 weeks until the lowest dose was reached; thereafter, the frequency was changed to every other day for 3 weeks, if tolerated. Subsequently, histamine receptor antagonists replaced proton pump inhibitors and followed the same deprescription regimen until discontinuation. Patient-specific interventions also included reassessment of therapeutic agents and dosage forms for more tolerable alternatives to facilitate deprescription efforts and minimize gastric ulceration or discomfort. Results: The pilot study enrolled 10 patients (average age 65.6 years, medication burden 16.8 units, and antisecretory duration 37.5 months). Physicians accepted >95% of interventions, and 90% of patients achieved cessation at 12 weeks. Post cessation, none of the patients needed antacid, prokinetic, or antisecretory agents at 4 weeks. Difficulties in order interpretation and transcription among nurses as well as order entry and calculations among pharmacists were noted. Conclusions: The present pilot study added to the growing body of evidence that gradual deprescription of antisecretory medications is feasible. Nonetheless, the pilot design precludes any conclusions about safety and efficacy of the intervention.

scholarly journals Long-term proton pump inhibitor use and the incidence of gastric cancer: A systematic review and meta-analysis

2020 ◽  
Vol 2 (1) ◽  
pp. 1-11
Author(s):  
Ju-Li Lin ◽  
Jian-Xian Lin ◽  
Chao-Hui Zheng ◽  
Jian-Wei Xie ◽  
Jia-bin Wang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Proton Pump Inhibitor ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Risk Ratios

Background: There are controverted whether the long-term use of proton pump inhibitors (PPI) will increase the risk of gastric cancer. We performed a meta-analysis to assess the risk of gastric cancer in PPI users compared with non-PPI users. Methods: The main inclusion criteria were original studies reporting the incidence of gastric cancer in PPI users compared with non-PPI users. Key outcomes were the risk ratios (RR) for gastric cancer in association with PPI users or non-PPI users. Results: We analyzed data from 8 studies, comprising more than 927,684 patients. The risk of gastric cancer in PPI users was significantly higher than in non-PPI users [RR= 2.10, 95% CI (1.17-3.97)]. The risk of gastric cancer was similar between the 2 groups when the duration was ≤1 year [RR= 2.18, 95% CI (0.66-7.11)]. While the risk of gastric cancer for PPI users was higher than in non-PPI users when the duration was between 1-3 years, ≥1 year, ≥3 years and ≥5 years. The risk of non-cardiac gastric cancer for PPI users was higher than for non-PPI users [RR= 2.66, 95% CI (1.66 -4.27)], and the risk of non-cardiac gastric cancer for PPI users was higher than for non-PPI users when the duration ≥1 year [RR= 1.99, 95% CI (1.03-3.83)], but the risk for cardiac gastric cancer was similar between the 2 groups [RR= 1.86, 95% CI (0.71-4.89)]. Conclusions: We found the long-term use of PPI (duration ≥1 year) was significantly associated with a higher risk of non-cardiac gastric cancer.

Prescribing of proton-pump inhibitors: auditing the management and reasons for prescribing in Danish general practice

2019 ◽  
Vol 36 (6) ◽  
pp. 758-764
Author(s):  
Dorte E Jarbøl ◽  
Jesper Lykkegaard ◽  
Jane M Hansen ◽  
Anders Munck ◽  
Peter F Haastrup
Keyword(s):  
General Practitioner ◽  
Proton Pump Inhibitor ◽  
General Practitioners ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Patient Characteristics ◽  
Clinical Settings ◽  
Staff Members ◽  
Term Basis

Abstract Background Prescribing of proton-pump inhibitors has substantially increased. Information from clinical settings is warranted to gain insight into reasons for prescribing. Aim To investigate Danish General Practitioners’ management and reasons for prescribing of proton-pump inhibitors and to identify areas for quality improvement. Methods All general practitioners in the Region of Southern Denmark and their staff were invited to participate in a 4-week audit on all contacts with patients prescribed proton-pump inhibitors. For each contact, patient characteristics, treatment duration, dose and causes of treatment, previous gastroscopy, Helicobacter pylori test, and decision about future treatment were recorded. Results A total of 51 general practitioners and 47 staff members sampled information about 1101 and 741 patients, respectively. Proton-pump inhibitors had been taken for more than 2 years in 58% of the cases, and 64% of the patients used it daily. Treatment was based on an appropriate reason in three of the four patients, most often due to acid-related symptoms. No gastroscopy had been performed in 46% of the patients, and one of four had had a consultation with the general practitioner regarding proton-pump inhibitor within the last year. Conclusion Most patients treated with proton-pump inhibitors are treated daily, on a long-term basis, and due to symptoms. Few consultations led to alterations in treatment, and only 25% of patients had a consultation regarding proton-pump inhibitor treatment with their general practitioner within the last year. Substantial variability between general practitioners with regard to management was detected.

scholarly journals GASTRIC FUNDIC GLAND POLYPS: CAN HISTOLOGY BE USEFUL TO PREDICT PROTON PUMP INHIBITORS USE?

2018 ◽  
Vol 55 (4) ◽  
pp. 380-384
Author(s):  
Hugo Leite de Farias BRITO ◽  
Cynthia BARROS ◽  
Marcelle Vieira FREIRE ◽  
Miraldo Nascimento da SILVA FILHO ◽  
Tereza Virgínia NASCIMENTO
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump Inhibitors ◽  
Parietal Cell ◽  
Proton Pump ◽  
Proton Pump Inhibitor Therapy ◽  
Inhibitor Therapy ◽  
Fundic Gland ◽  
Acid Therapy ◽  
Fundic Gland Polyps ◽  
Two Samples

ABSTRACT BACKGROUND: Fundic gland polyps allegedly increased in frequency in recent decades, and had attracted great attention due to possible association with prolonged proton pump inhibitor therapy. Prolonged use of this drug could cause parietal cell hyperplasia, obstruction of glandular lumen and cystic dilation of the gland. OBJECTIVE: This study aims to analyze clinical and pathological features of fundic gland polyps in patients with and without proton pump inhibitor therapy in a selected population from Brazil. METHODS: It was selected a sample of 101 Brazilian patients (78 females and 23 males), from a five years retrospective search of the files from a private pathology laboratory. The patients had an average age of 57 years and we included patients with a histological diagnosis of fundic gland polyp. The clinical data were obtained from their files and all histological slides were reviewed and examined with hematoxylin and eosin (HE) and Giemsa. RESULTS: Information about the use or non-use of proton pump inhibitors (PPI) was obtained in 84 patient files. In 17 cases we could not determine if PPI were used or not. Among those in which the information was available, a positive history of anti-acid therapy was observed in 63 (75.0%) patients. Parietal cell hypertrophy/hyperplasia and parietal cell protrusions were detected in most slides. Histological findings were identical in PPI users and PPI negative patients. Helicobacter pylori infection was detected in just two samples. Epithelial dysplasia or adenocarcinoma were not observed in our cases. Histopathological analysis of fundic gland polyps could not distinguish between PPI and non-PPI related cases. Parietal cell cytoplasmic protrusions, an alleged marker of prolonged acid suppression therapy, was detected in both groups. CONCLUSION: Histological features could not discriminate anti-acid therapy related fundic glands polyps in our patients.

scholarly journals Proton pump inhibitors and vascular function: A prospective cross-over pilot study

2015 ◽  
Vol 20 (4) ◽  
pp. 309-316 ◽  
Author(s):  
Yohannes T Ghebremariam ◽  
John P Cooke ◽  
Fouzia Khan ◽  
Rahul N Thakker ◽  
Peter Chang ◽  
...  
Keyword(s):  
Pilot Study ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Vascular Function

scholarly journals Proton Pump Inhibitors and Pain

2009 ◽  
Vol 6;12 (6;12) ◽  
pp. 1013-1023
Author(s):  
Howard Smith
Keyword(s):  
Iron Deficiency ◽  
Proton Pump Inhibitor ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Direct Evidence ◽  
Iron Absorption ◽  
Syndrome Patient ◽  
Restless Leg Syndrome ◽  
Over The Counter ◽  
Low Serum

There may be a relationship between proton pump inhibitors (PPIs) and iron absorption. PPIs may decrease the amount of iron absorbed gastrointestinally specifically due to alteration of the pH in the duodenum. Restless legs syndrome (RLS) is a sensorimotor disorder that includes an urge to move legs, accompanied or caused by uncomfortable and unpleasant sensations in the legs; the urge to move begins or worsens during periods of rest or inactivity, the urge to move is partially or totally relieved by movement, and the urge is worse or only occurs at night. In the majority of the restless leg syndrome population, the sensation is deep seated, often described as being in the shin bones, and most commonly felt between the knee and ankle. It may be described as a creepy, shock-like, tense, electric, buzzing, itchy, or even numb sensation. A subpopulation of this restless leg syndrome patient population experiences restless leg syndrome associated pain (RLSAP) that has been described as a deep “achy pain.” This pain has not been found to be relieved by many of the typical over the counter analgesics. Often, constant movement of the legs appears to be the only remedy, as these sensations usually appear during periods of rest. Furthermore, there appears to be an association between iron deficiency and those suffering from Restless Leg Syndrome (RLS). The authors theorize that there may be a possible correlation between PPIs and the symptoms (e.g. pain) associated with RLS. The authors propose that PPIs, such as omeprazole, may interfere with iron absorption in certain patients and that a subpopulation of patients who develop significant iron deficiency characterized by low serum ferritin levels while on PPIs may also develop RLS-like symptoms (including RLSAP). While there is no robust direct evidence to support any associations of PPIs and iron deficiency or PPIs associated with RLS-like symptoms (including RLSAP), it is hoped that this manuscript may spark research efforts on this issue. Key words: Proton pump inhibitor (PPI), Restless Leg Syndrome (RLS), iron deficiency, pain, iron absorption, Restless Leg Syndrome Associated Pain (RLSAP)

scholarly journals Deprescribing medications that may increase the risk of hepatic encephalopathy: A qualitative study of patients with cirrhosis and their doctors

2020 ◽  
pp. 205064062097522
Author(s):  
Sydni Williams ◽  
Jeremy Louissaint ◽  
Sam Nikirk ◽  
Jasmohan S Bajaj ◽  
Elliot B Tapper
Keyword(s):  
Hepatic Encephalopathy ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Qualitative Methodology ◽  
Patient Specific ◽  
Structured Interviews ◽  
Knowledge Gaps ◽  
Medication Discontinuation ◽  
Increased Risk ◽  
Specific Barriers

Background and aims Multiple medications are associated with an increased risk of incident hepatic encephalopathy. Despite this known risk, medications such as opioids, benzodiazepines, gabapentin/pregabalin, and/or proton pump inhibitors are increasingly prescribed to persons with cirrhosis. Deprescribing is a promising intervention to reduce the burden of hepatic encephalopathy. Given that deprescribing has not been trialed in cirrhosis, we evaluated the barriers and facilitators to safe and successful deprescribing in cirrhosis. Methods We conducted, transcribed, and analyzed semi-structured interviews using qualitative methodology with 22 subjects. This included eight patients with cirrhosis and recent use of opiates, benzodiazepines, gabapentin/Lyrica, and/or proton pump inhibitors as well as 14 providers (primary care, transplant surgery, transplant hepatology). Interviews explored opinions, behaviors, and understanding surrounding the risks and benefits of deprescribing. Results Major provider-specific barriers included deferred responsibility of the deprescribing process, knowledge gaps regarding the risk of hepatic encephalopathy associated with medications (e.g. proton pump inhibitors) as well as the safe method of deprescription (i.e. benzodiazepines), and time constraints. Patient-specific barriers included knowledge gaps regarding the cirrhosis-specific risks of their medications and anxiety about the recurrence of symptoms after medication discontinuation. Patients uniformly reported trust in their provider’s opinions on risks and wished for more comprehensive education during or after visits. Providers uniformly reported support for deprescription resources including pharmacist or nurse outreach. Conclusion Given knowledge of medication risks related to hepatic encephalopathy in patients with cirrhosis, deprescribing is universally seen as important. Knowledge gaps, inaction, and uncertainty regarding feasible alternatives prevent meaningful implementation of deprescription. Trials of protocolized pharmacy-based deprescribing outreach and patient-facing education on risks are warranted.

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