Schnoll-Sussman Felice, Katz Philip O
Jay Monahan Center for Gastrointestinal Health, Department of Gastroenterology and Hepatology, Weill Cornell Medicine, Cornell University, New York, NY, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Curr Treat Options Gastroenterol. 2017 Mar;15(1):1-9. doi: 10.1007/s11938-017-0115-5.
Proton pump inhibitors (PPI) are among the safest class of drugs used by all care providers, including gastroenterologists. They are the mainstay in treatment of acid-related disease, in particular, gastroesophageal reflux disease. Without them, many patients would experience a major decrement in their quality of life. However, no drug is without side effects or adverse events. In the past decade, numerous reports, principally case control studies and meta-analyses, have raised questions about important adverse events related to the use of PPIs. This has affected not only physicians' prescribing habits but patients' concerns about using these medications, particularly long term. Several FDA warnings are listed including those related to long bone fractures, interaction with clopidogrel, enteric infections, and hypomagnesaemia. More recently, concerns regarding PPIs and cardiovascular events have resurfaced as have issues related to kidney disease and dementia. The methodology of these studies allows us to find an association with these events but does not provide us with sufficient evidence to determine causality. In general, the findings of the available studies do not fit with our clinical experience nor is the magnitude of the association sufficient to result in a major change in our practice. Nevertheless, the recent literature has resulted in our careful reevaluation of PPI use across both FDA indications and in general. This article will critically review the literature regarding potential PPI adverse events and attempt to place them in perspective for the practicing physician.
质子泵抑制剂（PPI）是包括胃肠病学家在内的所有医疗服务提供者使用的最安全的药物类别之一。它们是治疗酸相关疾病，特别是胃食管反流病的主要药物。没有它们，许多患者的生活质量将大幅下降。然而，没有一种药物没有副作用或不良事件。在过去十年中，大量报告，主要是病例对照研究和荟萃分析，对与使用PPI相关的重要不良事件提出了质疑。这不仅影响了医生的处方习惯，也影响了患者对使用这些药物的担忧，尤其是长期使用。美国食品药品监督管理局（FDA）列出了几项警告，包括与长骨骨折、与氯吡格雷的相互作用、肠道感染和低镁血症相关的警告。最近，对PPI与心血管事件的担忧再次出现，与肾脏疾病和痴呆症相关的问题也是如此。这些研究的方法使我们能够发现与这些事件的关联，但没有为我们提供足够的证据来确定因果关系。一般来说，现有研究的结果与我们的临床经验不符，而且关联的程度也不足以导致我们的临床实践发生重大改变。尽管如此，最近的文献促使我们对FDA适应症范围内以及一般情况下PPI的使用进行了仔细的重新评估。本文将批判性地回顾有关PPI潜在不良事件的文献，并试图为执业医生正确看待这些事件。
