Long-term use of proton pump inhibitors as a risk factor for various adverse manifestations
Long-term use of proton pump inhibitors as a risk factor for various adverse manifestations
复制标题
DOI：
10.1016/j.therap.2020.06.019
复制
发表时间：
2021-01-29
期刊：
影响因子：
2.6
通讯作者：
Koyyada, Arun
中科院分区：
文献类型：
--
作者：
Koyyada, Arun
与其他抑酸剂（如组胺-2（H2）受体阻滞剂和抗酸剂）相比，长期使用质子泵抑制剂（PPI）可导致胃pH值升高、低氯血症，在某些情况下可导致无氯血症。长期使用PPI的这些后果可能导致严重的维生素（B-12和C）和矿物质（铁、钙和镁）缺乏，需要胃酸才能吸收和生物利用度。妊娠患者长期使用PPI可能会造成先天性畸形的潜在风险。多项研究建议通过保留PPI（奥美拉唑作为PPI的安全选择），将生活方式改变和抗酸药作为妊娠女性治疗胃食管反流病重度疾病的首选。PPI的长期酸抑制也可导致肠道、呼吸道和尿路感染。长期使用PPI引起的低氯血症可能诱发高胃泌素血症，最终介导胃息肉、胃类癌和胃癌的发生。PPI与抗血小板药物（如氯吡格雷）合并使用可使患者发生重大不良心脏事件。本综述收集了关于长期使用PPI引起的不良反应及其可能关系的全面信息。大量的研究如病例对照、随机试验、队列研究和荟萃分析都支持这些不良反应。临床医生和患者应谨慎对待这些影响，以避免严重后果。除非有适当的适应症，否则应避免长期使用PPI，主要用于老年人。(C)2020法国药理学和治疗学会。由Elsevier Masson SAS出版。All rights reserved.
The long-term use of proton pump inhibitors (PPIs) can lead to increased gastric pH, hypochlorhydria and in some cases to achlorhydria when compared to other acid-suppressing agents like histamine-2 (H2) receptor blockers and antacids. These consequences by the use of long-term PPIs may lead to significant vitamin (B-12 and C) and mineral (iron, calcium and mag- nesium) deficiencies which needs gastric acid for their absorption and bioavailability. Long-term use of PPIs by the pregnant patients may impose a potential risk of congenital malformations. Various studies have recommended the life style modifications and antacid use as first choice among pregnant womens by preserving PPIs (omeprazole as a safe choice of PPI) for severe conditions of gastroesophageal reflux disease. The long-term acid suppression by PPIs can also lead to enteric, respiratory and urinary tract infections. The hypochlorhydria by chronic PPIs use may induce hypergastrinemia, which ultimately mediates the gastric polyps, gastric carcinoids and gastric cancer. The concomitant use of PPIs with antiplatelet drugs like clopidogrel can impose the patients to major adverse cardiac events. This review has enlisted the comprehensive information regarding the adverse effects induced by long-term use of PPIs and their possible relations. Considerable studies like case-control, randomized trials, cohort studies and meta-analysis were reported in supporting these adverse effects. The clinicians and patients should be cautious about these effects so that they can avoid the serious outcomes. PPIs should be avoided for long-term use mainly in older adults unless there is a proper indication. (C) 2020 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.