Tag Archives: PPI

PPI and Poor Outcomes

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A large observation study provides some bad publicity for proton pump inhibitors (PPI):

BMJ Open Access: Risk of death among users of Proton Pump Inhibitors: a longitudinal
observational cohort study of United States veterans (Y Xie et al BMJ Open
2017;7:e015735. doi:10.1136/bmjopen-2016-01573) Thanks to Ben Enav for this reference.

This study selected ~350,000 patients from a database which identified more than 1.7 million PPI users. These patients were ‘new’ PPI users.

Key finding:  Over a median follow-up of 5.71 years, PPI use was associated with increased risk of death compared with H2 blockers use (HR 1.25, CI 1.23 to 1.28).

The authors note the limitations of this observational study; however, they suggest that the findings cannot be fully explained by residual confounders.  They recommend limiting PPI use to “instances and durations where it is medically indicated.”

My take: As noted in a recent post (see below), some risks attributed to PPIs in observational studies do not pan out.  Yet, PPI therapies need to be better-targeted to those who will truly benefit from them.

Related blog posts:

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Regurgitation harder to treat than heartburn, especially for NERDs

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While all pediatric gastroenterologists know that the title of this blog entry is right, it is helpful to have data.

A recent study (Clin Gastroenterol Hepatol 2012; 10: 612-19) used a reflux questionnaire to evaluate responsiveness of regurgitation from 2 randomized controlled trials.  The trials compared a newer acid blocker (AZD0865 dosed at 25-75 mg/day)) to esomeprazole (20-40 mg/day).  Patients had either non-erosive reflux disease (NERD , n=1460),  or reflux esophagitis, (RE, n=1314).  Inclusion criteria included the presence of substernal burning for ≥4 days/week.

Regurgitation-taste (RT), defined as an “acid taste in the mouth,” or regurgitation-movement (RM), defined as an “unpleasant movement of material upwards from the stomach” were analyzed.  Among NERD patients, either or both symptoms were present in 53% at baseline compared with 54% among the RE group.  In both NERD and RE patients, the presence of these regurgitation symptoms was associated with a poorer response to therapy.

  • Complete response of NERD patients with regurgitation symptoms:  RT 34%, RM 26%; in comparison to heartburn response of NERD patients which was 49%
  • Complete response of RE patients with regurgitation symptoms:  RT 44%, RM 33%; in comparison to heartburn response of NERD patients which was 55%

Additional references/blog entries: