Long-term proton pump inhibitor

Yang YX, Lewis JD, Epstein S et al. (2006) Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 296(24) 2947-2953... 

The clinical and fiscal impact of replacing omeprazole with lansoprazole as the only proton pump inhibitor has been assessed by reviewing the medical records of 3833 patients requiring long-term proton pump inhibitor therapy (2224 were started on lansoprazole and 1479 were converted from omeprazole to lansoprazole) (13). There were considerable pharmaceutical savings. The true lansoprazole failure rate (requiring conversion to omeprazole) was 5.3%. Withdrawal of lansoprazole was due to poor symptom control (in 69%) and/or adverse effects (in 22%). The most common adverse effects were diarrhea (10%), abdominal pain (5%), and urticaria (1%). 

Patients with gastroesophageal reflux disease receiving long-term proton pump inhibitor therapy... 

Hongo M, Fujimoto K, Gastric Polyps Study Group. Incidence and risk factor of fundic gland polyp and hyperplastic polyp in long-term proton pump inhibitor therapy a prospective study in Japan. J Gastroenterol 2010 45 618-24. 

Laine L, Ahnen D, McClain C et al. (2000) Review article potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors. Aliment Pharmacol Ther 14(6) 651-668... 

Geriatric Considerations - Summary Use of NSAIDs in older adults increases the risk of GI complications including gastric ulceration, bleeding, and perforation. These complications are not necessarily preceded by less severe GI symptoms. Concomitant use of a proton pump inhibitor or misoprostol reduces the risk for gastric ulceration and bleeding, but may not prevent long-term GI toxicity. No clinical data exist to support reduced GI toxicity with the use of diclofenac. 

GERD symptoms recur in over 80% of patients within 6 months after discontinuation of a proton pump inhibitor. For patients with erosive esophagitis or esophageal complications, long-term daily maintenance therapy with a full-dose or half-dose proton pump inhibitor is usually needed. Many patients with nonerosive GERD may be treated successfully with intermittent courses of proton pump inhibitors or H2 antagonists taken as needed ("on demand") for recurrent symptoms. 

Raghunath AS, O Morain C, McLoughlin RC. Review article the long-term use of proton-pump inhibitors. Aliment Pharmacol Ther. 2005 22(suppl l) 55-63. 

In patients receiving long-term therapy with proton pump inhibitors, the median 24-hour intragastric pH varies from 3.6 to 4.9 (esomeprazole 40 mg) the mean number of hours the pH is higher than 4 varies from 10.5 hours to 16.8. 

Proton pump inhibitors are widely used and possible adverse effects from very long term exposure, e.g. resistant symptoms from gastro-oesophageal reflux disease, are not yet known. 

A gastric carcinoid tumor, detected during long-term anti-ulcer therapy with a histamine receptor antagonist and proton pump inhibitors, has been reported (34). 

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