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Proton pump inhibitors: increased mortality

FEATURED REVIEW Proton pump inhibitors (PPIs) such as omeprazole are used in oesophagitis, gastroesophageal reflux disease and peptic ulcer disease. PPIs have few severe adverse effects in the short term. But this is not the case in the long term.
Full review (3 pages) available for download by subscribers.

Abstract

  • Proton pump inhibitors (PPIs) are widely used in oesophagitis, gastroesophageal reflux disease and peptic ulcer disease. They provoke few severe adverse effects in the short term, but this is not the case in the long term (infections, fractures, hyponatraemia, etc.).

  • A cohort study in about 350 000 patients in the United States, followed for 5.7 years, showed that patients receiving a PPI had a 25% increased risk of death compared with those receiving H2-receptor antagonists. In patients treated for more than one month, the risk appeared to increase with the duration of exposure. Other epidemiological studies have produced similar results.

  • These findings cast doubt on the harm-benefit balance of long-term and prophylactic PPI therapy. To address these risks, PPI withdrawal must be managed carefully and the use of alternative acid-suppressing agents should be considered.

©Prescrire 1 January 2019

"Proton pump inhibitors: increased mortality" Prescrire Int 2019; 28 (200): 13-15. (Pdf, subscribers only).

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Download the full review.
Pdf, subscribers only