2017-04-04 17:17:12 UTC

AGA Releases Best Practice Advice on Long-Term PPI Use

April 6, 2017

GIs should weigh the risks and benefits of PPIs when given for common conditions.

The long-term use of proton pump inhibitors (PPIs) by patients for GERD, Barrett’s esophagus and non-steroidal anti-inflammatory drug (NSAID) bleeding prophylaxis doubled in the U.S. from 1999 to 2012. Studies have shown that the number of adverse events doubled during the same period. 

In an AGA Clinical Practice Update published in Gastroenterology, Daniel E. Freedberg and colleagues determined that when PPIs are appropriately prescribed, their benefits are likely to outweigh their risks. Further, they state that there is currently insufficient evidence to recommend specific strategies for mitigating PPI adverse effects. They provide best practice advice based on expert opinion and on relevant publications:

  1. Patients with GERD and acid-related complications should take a PPI for short-term healing, maintenance of healing and long-term symptom control.
  2. Patients with uncomplicated GERD who respond to short-term PPIs should subsequently attempt to stop or reduce them. Patients who cannot reduce PPIs should consider ambulatory esophageal pH/impedance monitoring before committing to lifelong PPIs to help distinguish GERD from a functional syndrome. 
  3. Patients with Barrett’s esophagus and symptomatic GERD should take a long-term PPI.
  4. Asymptomatic patients with Barrett’s esophagus should consider a long-term PPI.
  5. Patients at high risk for ulcer-related bleeding from NSAIDs should take a PPI, if they continue to take NSAIDs.
  6. The dose of long-term PPIs should be periodically reevaluated so that the lowest effective PPI dose can be prescribed to manage the condition.
  7. Long-term PPI users should not routinely use probiotics to prevent infection.
  8. Long-term PPI users should not routinely raise their intake of calcium, vitamin B12 or magnesium beyond the recommended dietary allowance.
  9. Long-term PPI users should not routinely screen or monitor bone mineral density, serum creatinine, magnesium or vitamin B12.
  10. Specific PPI formulations should not be selected based on potential risks.

Talk to Your Patients
Discussions with your patients are necessary to ensuring high-quality patient care. To help your patients understand the importance of using PPIs as directed, AGA has developed talking points you can use to help facilitate discussions about the need to correctly use PPI for condition and symptom management. Learn more.

Join the discussion
Dr. Larry Kim has posted a case-based question in the AGA Community about PPI use, based on the AGA CPU. Answer the question and join the conversation. 

More on Barrett's Esophagus

Porcine Esophageal Submucosal Gland Culture Model Shows Capacity for Proliferation and Differentiation

Oct. 22, 2017

We describe a novel porcine 3-dimensional culture model that reproduces esophageal submucosal gland proliferation in vivo associated with cancer and injury.

Late Recurrence of Barrett’s Esophagus After Complete Eradication of Intestinal Metaplasia is Rare: Final Report From Ablation in Intestinal Metaplasia Containing Dysplasia Trial

Sept. 1, 2017

Endoscopic surveillance of patients with BE treated with radiofrequency ablation will likely be of diminishing value as the time since ablation grows.

Cost Effectiveness of Screening Patients With Gastroesophageal Reflux Disease for Barrett’s Esophagus With a Minimally Invasive Cell Sampling Device

Sept. 1, 2017

We found Cytosponge screening with endoscopic confirmation to be a cost-effective strategy.