Schubert Mitchell L
Division of Gastroenterology, Department of Medicine, Virginia Commonwealth University Health System.
Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA.
Curr Opin Gastroenterol. 2018 Nov;34(6):451-457. doi: 10.1097/MOG.0000000000000471.
The present review summarizes the past year's literature, both clinical and basic science, regarding potential adverse effects of proton pump inhibitors.
Proton pump inhibitors are amongst the most widely prescribed and overprescribed medications worldwide. Although generally considered well tolerated, epidemiologic studies mining large databases have reported a panoply of purported serious adverse effects associated with proton pump inhibitors, including chronic kidney disease, cognitive decline, myocardial infarction, stroke, bone fracture and even death. It should be noted that the quality of the evidence underlying these associations is very low and these studies, by design, cannot ascribe cause and effect. Nonetheless, these associations have been sensationalized in the media and misinterpreted by patients and providers. Unintended consequences of the fake news are that patients are not being prescribed and/or taking clinical guideline-recommended proton pump inhibitors to prevent and treat complications from gastroesophageal reflux disease and upper gastrointestinal bleeding precipitated by NSAIDs and dual antiplatelet therapies. In addition, physicians, who already have limited time to interact with their patients, are spending an inordinate amount of additional time placing these findings into proper perspective and reassuring their patients when initiating treatment as well as on every follow-up visit.
Most of the recent highly publicized serious adverse effects ascribed to proton pump inhibitors are not based on demonstrable evidence. Nevertheless, when proton pump inhibitors are prescribed long-term, they should be used at the lowest effective dose and the need for their use periodically reassessed.
本综述总结了过去一年中有关质子泵抑制剂潜在不良反应的临床和基础科学文献。
质子泵抑制剂是全球处方量最大且处方过度的药物之一。尽管通常认为其耐受性良好，但挖掘大型数据库的流行病学研究报告了一系列与质子泵抑制剂相关的所谓严重不良反应，包括慢性肾病、认知衰退、心肌梗死、中风、骨折甚至死亡。应当指出的是，这些关联背后证据的质量非常低，而且这些研究从设计上就无法确定因果关系。尽管如此，这些关联在媒体上被大肆渲染，患者和医疗服务提供者也对此产生了误解。虚假新闻带来的意外后果是，患者没有按照临床指南的推荐服用质子泵抑制剂来预防和治疗由非甾体抗炎药和双联抗血小板治疗引发的胃食管反流病及上消化道出血并发症。此外，医生本身与患者交流的时间就有限，在开始治疗时以及每次随访时，他们要花费大量额外时间来正确看待这些研究结果并安抚患者。
最近大肆宣扬的大多数归因于质子泵抑制剂的严重不良反应并无确凿证据。然而，当长期使用质子泵抑制剂时，应以最低有效剂量使用，并定期重新评估使用的必要性。
