PMID- 28257716
DCOM- 20170621
LR  - 20180405
IS  - 1528-0012 (Electronic)
IS  - 0016-5085 (Linking)
VI  - 152
IP  - 4
DP  - 2017 Mar
TI  - The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review 
      and Best Practice Advice From the American Gastroenterological Association.
PG  - 706-715
LID - S0016-5085(17)30091-4 [pii]
LID - 10.1053/j.gastro.2017.01.031 [doi]
AB  - BACKGROUND & AIMS: The purpose of this review is to evaluate the risks associated
      with long-term use of proton pump inhibitors (PPIs), focusing on long-term use of
      PPIs for three common indications: gastroesophageal reflux disease (GERD),
      Barrett's esophagus (BE), and non-steroidal anti-inflammatory drug (NSAID)
      bleeding prophylaxis. METHODS: The recommendations outlined in this review are
      based on expert opinion and on relevant publications from PubMed, EMbase, and the
      Cochrane library (through July 2016). To identify relevant ongoing trials, we
      queried To assess the quality of evidence, we used a modified
      approach based on the GRADE Working Group. The Clinical Practice Updates
      Committee of the American Gastroenterological Association has reviewed these
      recommendations. Best Practice Advice 1: Patients with GERD and acid-related
      complications (ie, erosive esophagitis or peptic stricture) should take a PPI for
      short-term healing, maintenance of healing, and long-term symptom control. Best
      Practice Advice 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. 
      The best candidates for this strategy may be patients with predominantly atypical
      symptoms or those who lack an obvious predisposition to GERD (eg, central
      obesity, large hiatal hernia). Best Practice Advice 3: Patients with Barrett's
      esophagus and symptomatic GERD should take a long-term PPI. Best Practice Advice 
      4: Asymptomatic patients with Barrett's esophagus should consider a long-term
      PPI. Best Practice Advice 5: Patients at high risk for ulcer-related bleeding
      from NSAIDs should take a PPI if they continue to take NSAIDs. Best Practice
      Advice 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. Best
      Practice Advice 7: Long-term PPI users should not routinely use probiotics to
      prevent infection. Best Practice Advice 8: Long-term PPI users should not
      routinely raise their intake of calcium, vitamin B12, or magnesium beyond the
      Recommended Dietary Allowance (RDA). Best Practice Advice 9: Long-term PPI users 
      should not routinely screen or monitor bone mineral density, serum creatinine,
      magnesium, or vitamin B12. Best Practice Advice 10: Specific PPI formulations
      should not be selected based on potential risks.
CI  - Copyright (c) 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.
FAU - Freedberg, Daniel E
AU  - Freedberg DE
AD  - Division of Digestive and Liver Diseases, Columbia University Medical Center, New
      York, New York. Electronic address:
FAU - Kim, Lawrence S
AU  - Kim LS
AD  - South Denver Gastroenterology, P.C., Littleton, Colorado.
FAU - Yang, Yu-Xiao
AU  - Yang YX
AD  - Divison of Gastroenterology, Perelman School of Medicine, University of
      Pennsylvania, Philadelphia, Pennsylvania.
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Gastroenterology
JT  - Gastroenterology
JID - 0374630
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Micronutrients)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Anti-Inflammatory Agents, Non-Steroidal/adverse effects
MH  - Bacterial Infections/chemically induced
MH  - Barrett Esophagus/*drug therapy
MH  - Dementia/chemically induced
MH  - Evidence-Based Medicine
MH  - Fractures, Bone/chemically induced
MH  - Gastroesophageal Reflux/*drug therapy
MH  - Gastrointestinal Neoplasms/chemically induced
MH  - Humans
MH  - Kidney Diseases/chemically induced
MH  - Micronutrients/deficiency
MH  - Myocardial Infarction/chemically induced
MH  - Peptic Ulcer Hemorrhage/chemically induced/*prevention & control
MH  - Practice Guidelines as Topic
MH  - Proton Pump Inhibitors/*administration & dosage/*adverse effects
MH  - Time Factors
EDAT- 2017/03/05 06:00
MHDA- 2017/06/22 06:00
CRDT- 2017/03/05 06:00
PHST- 2017/03/05 06:00 [entrez]
PHST- 2017/03/05 06:00 [pubmed]
PHST- 2017/06/22 06:00 [medline]
AID - S0016-5085(17)30091-4 [pii]
AID - 10.1053/j.gastro.2017.01.031 [doi]
PST - ppublish
SO  - Gastroenterology. 2017 Mar;152(4):706-715. doi: 10.1053/j.gastro.2017.01.031.