Proton Pump Inhibitors: Are we prescribing them right?

IBEROAMERICAN JOURNAL OF MEDICINE 04 (2021) 291-292

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Editorial

Proton Pump Inhibitors: Are we prescribing them right?

Eduardo Esteban-Zubero ®"

°Fmergency Department, Hospital San Pedro, Logrono, Spain

ARTICLE INFO

Article history:

Received 05 September 2021

Received in revised form 30 September 2021
Accepted 21 October 2021

Keywords:

Proton pump inhibitors
Prescription
Inadequate

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

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

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

INFO. ARTICULO

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
Prescripcion

Inadecuado

© 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 @ gmail.com

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

(http://creativecommons. org/licenses/by/4.0/).
https://doi.org/10.53986/ibjm.202 1.0056

In the endoscopic confirmation of peptic ulcer
disease

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
eradication

This is an open access article under the CC BY license

292 IBEROAMERICAN JOURNAL OF MEDICINE 04 (2021) 291-292

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

[8].

1. REFERENCES

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