与长期使用质子泵抑制剂相关的不良反应。

Adverse Effects Associated with Long-Term Use of Proton Pump Inhibitors.

作者信息

Maideen Naina Mohamed Pakkir

机构信息

Dubai Academic Health Corporation, Dubai, UAE.

出版信息

Chonnam Med J. 2023 May;59(2):115-127. doi: 10.4068/cmj.2023.59.2.115. Epub 2023 May 25.

Abstract

Proton Pump Inhibitors are used widely to manage many gastric acid-related conditions such as gastroesophageal disease, gastritis, esophagitis, Barrett's esophagus, Zollinger-Ellison syndrome, peptic ulcer disease, nonsteroidal anti-inflammatory drug-associated ulcers, and eradication, around the globe. This review article focuses on adverse effects associated with the long-term use of proton pump inhibitors. Various observational studies, clinical trials, and meta-analyses have established the adverse effects associated with the long-term use of proton pump inhibitors including renal disorders (acute interstitial nephritis, acute kidney injury, chronic kidney disease, and end-stage renal disease), cardiovascular risks (major adverse cardiovascular events, myocardial infarction, stent thrombosis, and stroke), fractures, infections ( infection, community-acquired pneumonia, and Coronavirus disease 2019), micronutrient deficiencies (hypomagnesemia, anemia, vitamin B12 deficiency, hypocalcemia, hypokalemia), hypergastrinemia, cancers (gastric cancer, pancreatic cancer, colorectal cancer, hepatic cancer), hepatic encephalopathy, and dementia. Clinicians including prescribers and pharmacists should be aware of the adverse effects of taking proton pump inhibitors for an extended period of time. In addition, the patients taking proton pump inhibitors for long-term should be monitored for the listed adverse effects. The American Gastroenterological association recommends a few non-pharmacological measures and the use of histamine 2 blockers to lessen gastrointestinal symptoms of gastroesophageal reflex disease and the utilization of proton pump inhibitors treatment if there is a definitive indication. Additionally, the American Gastroenterological association's Best Practice Advice statements emphasize deprescribing when there is no clear indication for proton pump inhibitors therapy.

摘要

质子泵抑制剂在全球范围内被广泛用于治疗多种与胃酸相关的病症,如胃食管疾病、胃炎、食管炎、巴雷特食管、卓-艾综合征、消化性溃疡病、非甾体抗炎药相关性溃疡以及根除幽门螺杆菌。这篇综述文章聚焦于长期使用质子泵抑制剂相关的不良反应。各种观察性研究、临床试验和荟萃分析已经证实了长期使用质子泵抑制剂相关的不良反应,包括肾脏疾病(急性间质性肾炎、急性肾损伤、慢性肾脏病和终末期肾病)、心血管风险(主要不良心血管事件、心肌梗死、支架血栓形成和中风)、骨折、感染(感染、社区获得性肺炎和2019冠状病毒病)、微量营养素缺乏(低镁血症、贫血、维生素B12缺乏、低钙血症、低钾血症)、高胃泌素血症、癌症(胃癌、胰腺癌、结直肠癌、肝癌)、肝性脑病和痴呆。包括开处方者和药剂师在内的临床医生应该意识到长期服用质子泵抑制剂的不良反应。此外,对于长期服用质子泵抑制剂的患者,应该监测是否出现所列的不良反应。美国胃肠病学会推荐了一些非药物措施以及使用组胺2受体阻滞剂来减轻胃食管反流病的胃肠道症状,并且在有明确指征时使用质子泵抑制剂进行治疗。此外,美国胃肠病学会的最佳实践建议声明强调,在没有明确指征进行质子泵抑制剂治疗时应逐渐停用。

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