Why PPIs should be used at lower doses and for shorter periods

Why PPIs should be used at lower doses and for shorter periods
Proton Pump Inhibitors have an increasing list of side-effects yet are more widely used, including in cancer treatment; a new expert review recommends they are used at lower doses and for shorter periods to avoid risk of side-effects.
 
A Proton Pump Inhibitor, or PPI, reduces the amount of acid produced in the stomach by approximately 70 per cent. The fact is you need stomach acid for proper digestion, and this is why PPI dosage should be controlled. 
 
PPIs work by irreversibly blocking an enzyme called H+/K+ ATPase, which is called the proton pump and is found in the stomach wall. Please note, this is a factor unique to the stomach and does not occur in the gut (intestines).
 
PPIs include Omeprazole, Pantoprazole, Lansoprazole, Esomeprazole, Dexlansoprazole and Rabeprazole.
 
PPIs are most commonly used to curb Acid Reflux (GERD), Heartburn, Hiatus hernia, Barrett's oesophagus or pain caused by stomach ulcers (including those caused by NSAIDs). 
 
PPIs and cancer
 
CANCERactive has previously covered research showing that usage can mask the presence of a highly treatable parasite, Helicobacter pylori, can also severely damage the gut microbiome, and three or more year usage has been linked with an eight-fold increase in stomach cancer risk (1).
 
Now the American Gastroenterological Association have produced new guidelines for PPI usage. These are extremely relevant to UK cancer patients who are all too often given the pills whilst having chemotherapy involving one or more drugs. The AGA advice runs counter to the widespread and often long-term usage recommend by UK oncologists. 
 
The AGA states that PPIs are being used increasingly for indications where their benefits are less certain and that overprescription is common and contributes to polypharmacy, where people can develop other illnesses by taking too many drugs. They also report that PPI use has been increasingly linked to a growing list of adverse events. The purpose of the AGA review was to set new standards for Best Practice. 
 
The AGA recommends that PPIs should be taken at the lowest dose and shortest duration possible for the condition being treated.
 
People taking a PPI, for whatever reason, should heed this advice.
 
 
 
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References
 
  1. Acid reflux pills cause up to 8 times the gastric cancer risk - https://www.canceractive.com/article/acid-reflux-pills-cause-8-times-the-cancer-risk
  2. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review; Laura E. Targownik, Deborah A. Fisher,
    Sameer D. Saini; Gasatroenterology, Feb 16, 2022

  Approved by the Medical Board. Click Here 


 

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