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• As Klepser, Collier, and Cochran (2013) noted, PPIs are a class of agents that reduce acid secretion by parietal cells in the stomach by irreversibly blocking H+/K+ adenosine triphosphate. They are commonly prescribed for many gastrointestinal (GI) conditions including gastric and duodenal ulcers, gastroesophageal reflux disease (GERD), upper gastrointestinal bleeding, and Helicobacter pylori infections. They are frequently utilized in the primary care setting. The purpose of this study was to examine the efficacy, usage, and current literature on PPIs.
• There were several complications noted with PPI usage. Gomm et al. (2016) found that that use of PPI is associated with an increased risk of dementia and that avoiding PPIs may contribute to the prevention of dementia. Klepser et al. (2013) concluded that PPIs were associated with renal disease after controlling for confounding conditions. They noted patients who had renal disease were twice as likely to have used PPIs in the past. In yet another study, Lazarus et al. (2016) concluded that PPI use is an independent risk factor for CKD and AKI, while H2 antagonist use is not. Shih et al. (2014) concluded PPI use was associated with an increased risk of myocardial infarction for both a 7- and 14- day window period. Finally, van der Hoorn et al. (2015) also determined that PPI use was associated with a substantially increased risk of requiring osteoporosis medication and fractures.
• Histamine-2-receptor antagonists (H2RAs) are often prescribed in place of PPIs. Sigterman et al. (2013) concluded that were superior to H2RAs in treating heartburn in patients both treated empirically and in patents with endoscopy-negative reflux disease (ENRD). PPIs were also noted to be more effective in patients requiring long-term treatment. H2RAs, however, were found to be superior to PPIs in speed of relief of symptoms and may be a better option for patients with only occasional symptoms.
• Rickenbacher et al. (2014) studied medical vs. surgical management of GERD. Their data showed a statistically significant pooled effect estimate in favor of fundoplication over medical management of GERD, although several patients complained of dysphagia after surgery. Nissen fundoplication has long been the surgical intervention of choice for GERD treatment. It has some drawbacks in that many patients complain of dysphagia and bloating post-surgery. Lal et al. (2017) compared laparoscopic Nissen fundoplication (LNF) to laparoscopic anterior partial fundoplication (LAPF) and found it to be just as effective as LNF for GERD treatment with less dysphagia.
Physician Assistant Studies
Master of Physician Assistant Studies (MPAS)
Fundoplicaton; Gastroesophageal Reflux – drug therapy; Gastroesophageal Reflux – surgery; Histamine H2 Antagonists – therapeutic use; Proton Pump Inhibitors – adverse effects; Proton Pump Inhibitors – therapeutic use; Comparative Study
Booke, Travis M., "Proton Pump Inhibitors (PPIs): A Review of the Efficacy, Usage, and Current Literature Recommendations" (2017). Physician Assistant Scholarly Project Posters. 32.