1.The appropriate use of Proton Pump inhibitors in adult patients admitted in the Intensive Care Unit of a tertiary hospital
Jacklyn M. So-Cabahug ; Leticia Ibañ ; ez-Guzman
Philippine Journal of Internal Medicine 2019;57(1):6-11
Introduction:
Proton pump inhibitors (PPI) have been used as stress ulcer prophylaxis (SUP) in intensive care unit (ICU) patients due to their high risk for stress-related upper gastrointestinal (GI) bleeding. With its dramatic increase in prescription, studies have noted its misuse and associated complications. This study aimed to determine the appropriateness of the use of PPIs in adult patients in the ICU of Medical Center Manila (ManilaMed).
Methods:
This eight-month study conducted a retrospective chart review, and analyzed through descriptive statistics using Stata 13. Out of 292 patients, 188 satisfied the inclusion and exclusion criteria. The indication of use of PPI was based on the American Society of Health-System Pharmacists (ASHP) Therapeutic Guidelines on SUP.
Results:
The patients were mostly male, median age of 62 years, stay in the ICU of five days, overall hospital stay of 13 days, and 75% were admitted from the emergency room. About 58% of PPIs were prescribed in the intravenous route for an average of 10 days, 38% of which is prescribed by cardiology consultants. Of the 73% of patients prescribed PPIs, most were septic and intubated for >48 hours, as well as being older and with longer overall hospital stay. Only 53.7% were prescribed appropriately; adverse outcomes included pneumonia, GI bleeding, anemia, renal failure, combined complications and overall mortality.
Discussion:
The 46% inappropriate use of PPIs may indicate its routine use was common. The adverse outcomes, despite appropriate use, cannot be concluded as having causative effect owing to the nature of the study and given the possibility that these patients may have been sicker on admission hence prescribed the PPI.
Conclusion
Results indicated that PPI prescription in the ICU were mostly guidelines compliant. This paper recommends the development of ManilaMed’s own strategies to minimize its inappropriate use, in turn allowing proper allocation of funds and maximizing medical treatment.
Proton Pump Inhibitors
2.The Perilous PPI: Proton Pump Inhibitor as a Cause of Clinically Significant Hypomagnesaemia
Yong Ting Tai ; Chin Vong Tong
Journal of the ASEAN Federation of Endocrine Societies 2020;35(1):109-113
Proton pump inhibitors (PPIs) are the mainstay of therapy for all gastric acid related diseases and are commonly used in current clinical practice. Although widely regarded as safe, PPIs have been associated with a variety of adverse effects, including hypomagnesaemia. The postulated mechanism of PPI-related hypomagnesaemia involves inhibition of intestinal magnesium absorption via transient receptor potential melastin (TRPM) 6 and 7 cation channels. PPI-induced hypomagnesaemia (PPIH) has become a well recognized phenomenon since it was first reported in 2006. Clinical concerns arise from growing number of case reports presenting PPIH as a consequence of long-term PPI use, with more than 30 cases published to date. In this article, we report 2 cases of PPIH associated with the use of pantoprazole. Both patients presented with severe hypomagnesaemia and hypocalcaemia. One of them had associated hypokalemia and cardiac arrhythmia. A casual relation with PPIs postulated and supported by resolution of electrolyte abnormalities after discontinuation of PPIs.
Proton Pump Inhibitors
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Hypokalemia
3.Proton Pump Inhibitors Reduce the Size and Acidity of the Gastric Acid Pocket.
Journal of Neurogastroenterology and Motility 2015;21(1):133-134
No abstract available.
Gastric Acid*
;
Proton Pump Inhibitors*
4.Can Proton Pump Inhibitors Increase Incidence of Nonsteroidal Anti-inflammatory Druginduced Small Bowel Injury?.
The Korean Journal of Gastroenterology 2016;68(2):123-125
No abstract available.
Incidence*
;
Proton Pump Inhibitors*
;
Proton Pumps*
;
Protons*
5.Is hypomagnesemia associated with using proton pump inhibitors?.
Kidney Research and Clinical Practice 2016;35(2):128-129
No abstract available.
Proton Pump Inhibitors*
;
Proton Pumps*
;
Protons*
6.Can Nocturnal Acid-breakthrough Be Reduced by Long-acting Proton Pump Inhibitors?.
Journal of Neurogastroenterology and Motility 2017;23(2):145-148
No abstract available.
Proton Pump Inhibitors*
;
Proton Pumps*
;
Protons*
7.The Effect of Proton Pump Inhibitors on Nutrition, Metabolism, Infection and Small Intestinal Bacterial Overgrowth: Safe Perspective.
Korean Journal of Medicine 2011;81(1):11-16
Proton pump inhibitors (PPIs) have been widely used to treat patients with acid-related disorders because they are perceived to be safe and effective. However, they have the potential for side effects. Many studies have examined the side effects of long-term PPI exposure. We review the side effects of long-term PPIs, focusing on nutrition, metabolism, and infection.
Humans
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Proton Pump Inhibitors
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Proton Pumps
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Protons
8.Proton Pump Inhibitor-Responsive Esophageal Eosinophilia: Controversies and Its Clinical Implications.
Gut and Liver 2016;10(1):1-2
No abstract available.
*Eosinophilia
;
Eosinophilic Esophagitis
;
Humans
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*Proton Pump Inhibitors
9.Effect of proton pump inhibitors on Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in patients with laryngopharyngeal reflux: A systematic review and meta-analysis
Patricia Ann U. Soriano ; Erasmo Gonzalo D.V. Llanes ; Anna Pamela C. Dela Cruz ; Kevin Michael L. Mendoza
Philippine Journal of Otolaryngology Head and Neck Surgery 2022;37(1):6-14
Objectives:
The purpose of this study was to determine the efficacy of proton pump inhibitor (PPI) therapy in treating the symptoms and laryngeal findings of laryngopharyngeal reflux (LPR).
Methods:
Placebo-controlled, randomized clinical trials published after June 2001 to January 2021 which used PPI as the sole intervention and the RSI or RFS as outcome measures were eligible for inclusion. Studies that were published prior to June 2001, those which only made use of questionnaires other than the RSI or RFS, those which used PPI in combination with other treatments, or those with unavailable full-text manuscripts were excluded. These studies were identified from MEDLINE, Scopus, Cochrane Library, Embase, and HERDIN Plus databases which were searched from May 21 to 26, 2020. The primary outcome was the mean difference between baseline/pre-treatment and post-treatment RSI scores for both PPI and placebo groups. The secondary outcome was the mean difference between pre-treatment and post-treatment RFS scores for PPI and placebo groups. Aggregate results of these outcomes were analyzed using forest plots. Heterogeneity was determined through prediction intervals. Risk of bias of individual studies was assessed using the Cochrane Collaboration’s Tool in Assessing Risk of Bias.
Results:
Nine randomized control trials were included with a total of 737 patients randomized and 595 patients analyzed – 294 from the PPI group and 301 from the placebo group. There were notable variations among the studies in terms of choice of PPI, dosage and frequency. Out of nine studies, four used both RSI and RFS in their analysis. Two studies used RSI alone and three used the RFS in combination with symptom questionnaires other than the RSI. There was a significant decrease in the RSI of the PPI group versus the placebo group with a mean difference of -2.83 (95% CI, -5.13 to -0.53, p = .02). However, there was no significant decrease in the RFS between PPI and placebo groups with a mean difference of -0.84 (95% CI, -2.66 to 0.98, p = .37). For two clinical trials which only reported post-treatment RFS, there was also no significant difference between the two treatment groups with a mean difference of 1.27 (95% CI, -0.22 to 2.76, p = .10).
Conclusion
This meta-analysis found that, although a statistically significant benefit in RSI was noted with PPI therapy, this difference may not translate to a clinically significant change in symptoms; therefore, there is insufficient evidence to recommend for or against the treatment of LPR with PPIs.
Laryngopharyngeal Reflux
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Proton Pump Inhibitors
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Laryngitis
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Hoarseness