Did You Know?

Proton pump inhibitors are estimated to cost Americans 11 billion dollars each year.

Proton-pump inhibitors (PPIs) are a group of drugs that are used to treat gastric issues. However, long-term usage of PPIs can lead to various side-effects. So it’s really important to take PPIs as recommended by your health care provider. Here are few things that you must need to know before using PPIs:

Which Conditions are Appropriate for Short-Term PPI Use?

Here are some conditions in which an individual can use PPI for short period of time.

a. GERD

• An individual can go for an eight week PPI therapy course at an initial stage.
• Individuals on long-term usage are recommended with a trial of lower dose, on-demand therapy, or intermittent therapy to minimize exposure.

b. Gastric and Duodenal Ulcers

An individual can be recommended with FDA approved regimens to heal ulcers. It might take 4-8 weeks of time to heal.

c. Pylori

Health care provider can recommend an individual with first-line PPI-containing regimens.

d. Stress Ulcer Prophylaxis

Reserve stress ulcer prophylaxis with PPIs for ICU patients with at least one of the following:

• Coagulopathy (platelet count 1.5, or aPTT >2 times control)
• Mechanical ventilation for >48 hours
• History of GI ulceration or bleeding within one year of admission
• Thermal injury to >35% of body surface area
• Multiple trauma
• Hepatic failure
• Partial hepatectomy
• Glasgow Coma score ≤10
• Transplantation preoperatively in the ICU
• Spinal cord injury

Few of the side-effects an individual can experience are:

• Occult bleeding lasting at least six days
• Sepsis
• ICU stay of more than one week
• High-dose corticosteroids (>250 mg/day of hydrocortisone)

Which Conditions May Require Long-Term PPI Therapy?

Refractory GERD

An individual not responding to short term Ppi Therapy after 2-3 months, might need to under-go long-term PPI therapy.

• An individual can be recommended to take H2 blocker as a bedtime dosage for nighttime symptoms.
• Healthcare provider can change PPI, or may double the dose, or add Metoclopramide to individuals not responding to short term PPI.

Erosive Esophagitis

• Health care providers might consider maintenance PPI therapy with continued symptoms after an 8 week trial of PPI. The dose and length of therapy is determined by the severity of disease and the specific PPI being used.
• Doctors’ can recommend lowest effective dose, including on-demand or intermittent therapy during maintenance therapy.

Zollinger-Ellison Syndrome

• Higher PPI doses at an initial stage. Doctors’ can lower the dosage as gastric output decreases.
• If gastric output volumes are not an option, doctors’ might suggest using symptom control (e.g., pain, diarrhea) to monitor dosage titrations.
• Recommend using the lowest effective dose.

NSAID-Induced Ulcers

• Patients with ulcer history, might be recommended with PPI with an NSAID to reduce the incidence of recurrent bleeding by 4% to 6% over a six-month period.
• Moreover, PPI use with COX-2 inhibitors decreases recurrent bleeds by almost 9% over one year.
• Doctors’ can recommend PPIs with a COX-2 inhibitor for patients with a GI bleed history.

Chronic Anticoagulation After a GI Bleed

• Recommend PPIs for patients on anticoagulants after an upper GI bleed.

Barrett’s Esophagus

• Individuals suffering from Barrett’s esophagus are recommended with once-daily treatment with a PPI.
• They may also reserve double daily dose for individuals with poor control on once-daily PPI therapy.

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