1 1 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 7
You've probably heard about the
studies linking proton pump
inhibitors (PPIs) to a wide variety of
adverse events, including kidney dis-
ease, dementia, fractures, infection
and vitamin or mineral deficiencies.
Keep in mind, however, that accord-
ing to the American Gastroenterological Association, "the quality
of evidence supporting these findings is low to very low." Plus,
they add, the odds that patients taking PPIs will experience these
events are only a tiny bit higher (less than 1% per patient, per
year) than they are in patients not taking PPIs.
That doesn't mean there's no risk, of course. We don't know for
sure yet. But frankly, I'm not overly concerned. I've been pre-
scribing PPIs for more than 20 years and have yet to see even one
of the complications that have been reported in the popular press.
Yes, we should be cautious. We shouldn't prescribe PPIs to
people who don't need them, and we should always strive for the
lowest dose that controls symptoms and inflammation. But we
shouldn't rush toward other interventions when we can use
medical therapy to manage GERD.
H2-receptor antagonist blockers can also be effective if
patients have mild or low-grade symptoms (and are concerned
about the reported potential side effects of PPIs), but there's no
question that PPIs control symptoms better, do a better job of
healing erosive esophagitis and are better at maintaining healed
erosive esophagitis. — Ronnie Fass
PROTON PUMP INHIBITORS?
Keeping the PPI Scare in Perspective
• QUESTIONABLE DATA
Concerns about proton pump
inhibitors may be overblown.
