Alternative medicines

Proton Pump Inhibitors: Considerations with Long-Term Use – Physician’s Weekly

Summary

John Pandolfino, MD
Chief of Gastroenterology and Hepatology
Department of Medicine
Hans Popper Professor
Professor of Medicine, Gastroenterology and Hepatology
Feinberg School of Medicine, Northwestern University

Symptoms of gastroesophageal reflux disease (GERD), the most common esophageal disorder encountered in US, are associated with a negative quality of life and increased healthcare costs and therefore require an effective management strategy. Although proton pump inhibitors (P…….

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John Pandolfino, MD
Chief of Gastroenterology and Hepatology
Department of Medicine
Hans Popper Professor
Professor of Medicine, Gastroenterology and Hepatology
Feinberg School of Medicine, Northwestern University

Symptoms of gastroesophageal reflux disease (GERD), the most common esophageal disorder encountered in US, are associated with a negative quality of life and increased healthcare costs and therefore require an effective management strategy. Although proton pump inhibitors (PPIs) remain the primary treatment of GERD, they do not cure the disorder and can leave patients with persistent symptoms despite treatment. Moreover, patients are still at risk of developing such complications as peptic strictures, Barrett’s metaplasia, and esophageal cancer.

Transoral incisionless fundoplication (TIF) is an advanced, incisionless endoscopic procedure that treats the underlying cause of GERD. In cases when medications are no longer effective, it is a successful alternative in the armamentarium of GERD treatment. Individuals who can benefit from the TIF procedure include:

  • Patients with typical GERD symptoms and suboptimal control of their symptoms on PPIs who do not have a large hiatal hernia or esophageal motility problems
  • Patients with GERD symptoms and mild to moderate anatomic abnormalities of the gastroesophageal junction valve function that require correction
  • Patients preferring an alternative management strategy for their GERD that does not involve long-term medication use

Physician’s Weekly interview John Pandolfino, MD, to discuss the use of PPIs in patients with GERD, and when alternative treatment therapies should be considered:

Physician’s Weekly: Can you explain why long-term use of proton pump inhibitors to treat GERD is generally not advised?

Dr. Pandolfino: Proton pump inhibitors (PPIs) have revolutionized the way we treat acid peptic diseases. We can prevent ulcers and effectively treat the majority of people with reflux disease with these medications. But, as with any medications, they interrupt the homeostasis of the body. The reducing of acid secreted into the stomach with chronic PPIs can negatively impact one’s microbiome, or their ability to absorb certain nutritional components, vitamins, and minerals. While I think they are very safe medicines, patients should not take a medication if they don’t have to because of that effect on homeostasis.

The package inserts on many PPIs scare patients who see the 2-4-week limitation for treatment, but that was included not because of an untoward risk but as a safety mechanism so that patients would eventually see their physician and not put themselves on a PPI and continue it indefinitely. Patients need a physician to determine if a PPI is the right medicine for them and if they need it long-term; Results from multiple studies indicate that about 50% of people who take PPIs for GERD don’t have actual evidence of the disease.

What indicators should physicians recognize that PPIs are not efficiently managing a patient’s GERD?
If a patient doesn’t achieve at least …….

Source: https://www.physiciansweekly.com/proton-pump-inhibitors-considerations-with-long-term-use/