Ppi symposium araz.

1. Dr. Araz Lateef
MBChB-FICMS- Int Med- Kurdistan Board GEH
Consultant Gatroenterologist & hepatologist.
1

2. Introduction:
• The possible side effects of Long-term PPIs include:
• Gastric carcinoids
• Gastric carcinoma
• Decreased absorption of minerals (e.g., iron, calcium)/ vitamin B-
12,magnesium.
• Fractures.
• Enteric infections (e.g., C . difficile.)
• Pneumonia.
• CV events.
• Recently associations with (CKD) &dementia.

3. Long-term PPI side effects : CVD,CKD,Dementia:
• Hazard ratios for PPI use & dementia or CKD were ≤1.5 &when
hazard ratio<2 , it is not possible to determine whether the
association is valid or the result of residual bias.
• if a true cause-&-effect exists, even small effect sizes can result in
meaningful risk for common interventions&conditions.

4. LONG-TERM PPI USE: what to tell patients
• Dementia &CKD
• We cannot conclude that these associations are valid&patients
should not accept these reports as fact,but we cannot conclude that
risks do not exist.
• But benefits outweigh potential risk.
• If PPIs are indicated, using the lowest effective dose &if possible,
intermittent rather than daily therapy hopefully should decrease
the risk of potential side effects.
• NSAIDs/anti-platelets

5. LONG-TERM PPI USE: Fundal gland polyps
• fundic-gland polyps have little, if any, clinical significance,
• They generally are not dysplastic
• Do not progress to premalignant or malignant lesions

6. LONG-TERM PPI USE: what to tell patients
• Inappropriate/unstated indications:
• The most important intervention we perform is stopping PPIs in the
many patients without appropriate indications.
• For example, many hospitalized patients receive PPIs, which are
then continued as outpatient treatment& PPI use is inappropriate in
~70–80% of these patients.
• Even uncertain rare risk is unacceptable if a medication provides no
clear benefit.

7. Stop inappropriate use of PPI:
• The most common inappropriate indication for PPI
treatment is prevention of gastric damage, often associated
with drugs that have not proved to be harmful to the gastric
mucosa.
• Prophylaxis for stress ulcer during hospitalization in low-risk
patients is another common inappropriate indication.
• inappropriate PPI prescription rates at admission remain
identical at discharge with figures as high as 75% of all cases
without an acceptable indication.