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Proton Pump Inhibitors: Are we prescribing them right? 

Eduardo Esteban-Zubero ®" 

°Fmergency Department, Hospital San Pedro, Logrono, Spain 


Article history: 

Received 05 September 2021 

Received in revised form 30 September 2021 
Accepted 21 October 2021 


Proton pump inhibitors 

© 2021 The Authors. Published by Iberoamerican Journal of Medicine. This is an open access article under the CC BY license 


Inhibidores de la bomba de protones: ;los prescribimos bien? 


Historia del articulo: 

Recibido 05 Septiembre 2021 

Recibido en forma revisada 30 Septiembre 2021 
Aceptado 21 Octubre 2021 

Palabras clave: 
Inhibidores de la bomba de protones 


© 2021 Los Autores. Publicado por Iberoamerican Journal of Medicine. Este es un articulo en acceso abierto bajo licencia CC BY 

(http://creativecommons. org/licenses/by/4.0/). 

HOW TO CITE THIS ARTICLE: Esteban-Zubero E. Proton Pump Inhibitors: Are we prescribing them right? Iberoam J Med. 

2021;3(4):291-292. doi: 10.53986/ibjm.2021.0056. 

Proton pump inhibitors (PPIs) are the group of drugs of 
choice in the treatment of various gastrointestinal 
pathologies related to acid secretion. The most extensively 
used PPI is omeprazole, accounting for 80% of the total 
consumption of antiulcer drugs and 6.2% of the total drug 
packages dispensed under the National Health System in 
Spain [1]. Its therapeutic indications are clear, including: 

e Gastroesophageal reflux disease (GERD) with and 

without esophagitis 

* Corresponding author. 
E-mail address: eezubero @ 

ISSN: 2695-5075 / © 2021 The Authors. Published by Iberoamerican Journal of Medicine. 

(http://creativecommons. org/licenses/by/4.0/). 1.0056 

In the endoscopic confirmation of peptic ulcer 

Non-ulcer dyspepsia 

Barrett's esophagus 

Zollinger Ellison syndrome 

Peptic esophageal stenosis due to scleroderma 
Short treatment of ulcer disease as part of the 
treatment regimen for AHelicobacter pylori 

This is an open access article under the CC BY license 


e Prophylaxis in the use of non-steroidal anti- 
inflammatory drugs (NSAIDs), especially when an 
increased risk of dyspepsia or ulceration can be 
deduced. In the latter case, at least two of the 
following criteria must be met: patients over 65 
years of age, history of peptic ulcer disease, 
previous serious gastrointestinal complications 
(gastrointestinal bleeding), concomitant use of 
steroids or oral anticoagulants, prolonged use of 
high doses of NSAIDs, presence of comorbidity 
with cardiovascular, kidney or liver disease, 
diabetes, and hypertension [2]. 

However, despite the clarity of the prescription, an 
inappropriate use of this type of drug is observed in routine 
clinical practice. Some of the theories that can explain this 
are the belief in the gastric "protection" of these drugs 
against any external agent, which sometimes implies 
significant pressure from the patient or relatives (especially 
in polymedicated patients). On other occasions, it may be 
due to ignorance of the physician, which also lasts over time 
given the difficulty that is sometimes appreciated when 
withdrawing PPIs [3]. This inappropriate prescription has 
been seen in case series ranging from 15% to 60% [3-5]. 

It should be noted that these drugs have a very high safety 
profile, although they are not free from possible adverse 
effects. For example, the incidence of headache with 
lansoprazole is greater than 1%. In addition, by increasing 
the dose of this drug, diarrhea occurs more frequently. This 
digestive disturbance has not been observed in other PPIs 
[6]. In addition, a possible increased risk of hip fracture has 
been observed [7]. 

For this reason, adequate adherence to clinical practice 
guidelines is necessary to prescribe these treatments. Doing 
so would not only avoid possible adverse effects, but it 
would also mean significant savings in pharmaceutical costs 



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