Long-term proton pump inhibitor therapy

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. 

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. 

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. 

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

Haga Y, Nakatsura T, Shibata Y, Sameshima H, Nakamura Y, Tanimura M, Ogawa M. Human gastric carcinoid detected during long-term antiulcer therapy of H2 receptor antagonist and proton pump inhibitor. Dig Dis Sci 1998 43(2) 253-7. 

Some clinicians believe that patients should be offered the newer endoscopic interventions instead of proton pump inhibitors for long-term maintenance of GERD. While the newer endoscopic therapies provide good results and less recovery time than surgery, the long-term effects are still not known. Conversely, many patients prefer not to have to take medication indefinitely, and in some cases still complain of symptoms despite drug therapy. 

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