Department of Otolaryngology, Center for Voice and Swallowing Disorders, Wake Forest University Health Sciences, Winston Salem, North Carolina, USA.
J Voice. 2011 Mar;25(2):236-40. doi: 10.1016/j.jvoice.2009.10.015. Epub 2010 Feb 9.
Proton pump inhibitors (PPIs) are the mainstay of current medical management for laryngopharyngeal reflux, and treatment often involves long-term use of this class of medications. The long-term adverse effects of PPI use have not been studied extensively, but several analyses have demonstrated epidemiological links between PPI use and adverse outcomes. These include altered mineral and vitamin absorption, orthopedic injury, acute coronary syndromes (ACS), and infectious risks.
A PubMed search was performed for subject headings, including PPIs and adverse outcomes. Relevant studies were included in this review. Studies were compiled, reviewed, and compared in a narrative form.
Several epidemiological links between PPI use and metabolic, infectious, cardiac, and orthopedic adverse outcomes were found. No definite causal effects were identified.
Given these epidemiological patterns, we recommend that the clinician be aware of these possible unintended consequences. In addition, we recommend consideration of dual-energy X-ray absorptiometry (DEXA) bone density scans in at-risk patients who have not been previously tested. We recommend consideration of vitamin B₁₂ and iron levels in selected patients who are at high risk. We also recommend close communication with our cardiology colleagues, as we attempt to ascertain the relationship between clopidogrel and PPI use. We recommend caution in the use of omeprazole in patients undergoing active treatment for ACS. Finally, we recommend consideration of Helicobacter pylori or serum gastrin level testing in patients with known risk factors for gastric carcinoma.
质子泵抑制剂 (PPIs) 是目前治疗喉咽反流的主要药物，治疗通常涉及此类药物的长期使用。PPIs 使用的长期不良反应尚未得到广泛研究，但有几项分析表明，PPIs 使用与不良后果之间存在流行病学联系。这些包括矿物质和维生素吸收改变、骨科损伤、急性冠状动脉综合征 (ACS) 和感染风险。
对包括 PPIs 和不良后果在内的主题词进行了 PubMed 搜索。本综述纳入了相关研究。以叙述性形式对研究进行了汇编、审查和比较。
发现 PPI 使用与代谢、感染、心脏和骨科不良后果之间存在几种流行病学联系。未确定明确的因果关系。
鉴于这些流行病学模式，我们建议临床医生注意这些可能的意外后果。此外，我们建议对以前未接受过检查的高危患者考虑进行双能 X 线吸收法 (DEXA) 骨密度扫描。我们建议在有高风险的特定患者中考虑维生素 B₁₂ 和铁水平。我们还建议与我们的心脏病学同事密切沟通，以确定氯吡格雷和 PPI 使用之间的关系。我们建议在接受 ACS 积极治疗的患者中谨慎使用奥美拉唑。最后，建议考虑有已知胃癌危险因素的患者进行幽门螺杆菌或血清胃泌素水平检测。
