Using proton pump inhibitors?

Rich66 · 07-16-2009, 02:14 PM

Suggestion today that some of mom's upper ab discomfort is probably due to Navelbine induced excess acid. Proton pump inhibitor suggested. She does have compazine and tried it for the first time today. Not sure if this alone would reign things in. Other types of acid reducers were said to have negative interaction possibilities.
Even before PPI was suggested, I was coming across articles on downsides of PPIs. I know it's a risk/benefit issue but..any thoughts?

examples:

http://download.journals.elsevierhea...850900780X.pdf

Proton Pump Inhibitors May Induce Acid Symptoms
Increased symptoms seen after therapy withdrawal suggest drugs cause dependency
Publish date: Jul 2, 2009

THURSDAY, July 2 (HealthDay News) -- After proton pump inhibitor therapy is withdrawn, patients may be likely to experience acid-related symptoms, according to a study published in the July issue of Gastroenterology.
Christina Reimer, M.D., of Copenhagen University in Denmark, randomly assigned 120 healthy volunteers to receive 12 weeks of placebo or eight weeks of esomeprazole at a dosage of 40 mg/d followed by four weeks with placebo.
During weeks nine through 12, the researchers found the esomeprazole group was significantly more likely than the placebo group to report at least one acid-related symptom (44 versus 15 percent). At weeks 10, 11, and 12, they also found that the esomeprazole group had higher rates of dyspepsia, heartburn, or acid regurgitation (22, 22, and 21 percent, respectively) than the placebo group (7, 5, and 2 percent, respectively).
"We find it highly likely that the symptoms observed in this trial are caused by rebound acid hypersecretion and that this phenomenon is equally relevant in patients treated long term with proton pump inhibitors," the authors conclude. "These results justify the speculation that proton pump inhibitor dependency could be one of the explanations for the rapidly and continuously increasing use of proton pump inhibitors."
Authors of the study reported financial relationships with manufacturers of proton pump inhibitors.
Abstract
Full Text

Title: Proton Pump Inhibitors May Increase Risk for Clostridium difficile Outbreaks: Presented at ICC
"Proton Pump Inhibitors May Increase Risk for Clostridium difficile Outbreaks: Presented at ICC"

By Louise Gagnon TORONTO -- June 22, 2009 -- Taking proton pump inhibitors (PPIs) increases the potential for outbreaks of [Clostridium difficile, according to a case-control study presented here at the International Congress of Chemotherapy and Infection (ICC) on June 20. Researchers studied whether an association exists between the use of PPIs and C difficile-associated disease (CDAD) that is nosocomially acquired.

Although it is well established that the prescription of antibiotics raises the potential for an outbreak of C difficile, other factors that augment the possibility of an outbreak are not as well known, explained Stephanie Linney, Sudbury Regional Hospital, Sudbury, Ontario, who conducted the study while completing her pharmacy residency at Trillium Health Centre, Mississauga, Ontario, where an outbreak of CDAD had occurred.

"The contribution of PPIs is a controversial topic," she noted. PPIs have been implicated in the development of CDAD because they dramatically decrease the bactericidal effect of gastric acid.

Patients in the study were matched for age, sex, the date of hospitalisation, and the hospital unit to which they were admitted. The study comprised 142 cases and 142 control subjects. Current use of a PPI was defined as use on the date that the C difficile diagnosis came back positive. Past use was defined as the use of a PPI in the past 30 days.

"We didn't find any association between current use of PPIs and a diagnosis of C difficile," Linney said. "We did find, however, that past use could be a contributor."

Specifically, the researchers found that the odds ratio (OR) between current use and CDAD outbreak was 1.0, and the OR between past use of a PPI and CDAD was 2.4.

Antibiotic use has been found to be highly associated with the development of CDAD, with an OR of 12.0.

The presence of diabetes, enteral feeds, cancer, gastrointestinal surgery, inflammatory bowel disease, and institutionalisation did not play a role in the development of hospital-acquired CDAD, according to the retrospective analysis.

"Our suggestion is that if you have a patient who does develop CDAD, you should explore all options," said Linney. "You need to reassess if [patients] do actually need their PPIs. We suggest using an H2 antagonist instead, unless a PPI is absolutely needed."

[Presentation title: Association Between the Use of Proton Pump Inhibitors and a Clostridium difficile-Associated Disease Outbreak: A Case-Control Study. Abstract P289]

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