The prevelance of inapproperiate use of proton pump inhibitors and its associated side effects among Basrah city population

Main Article Content

Sheima N. Kadhim
Asmaa M. Al-Ali
Muntadher L. Abdulsahib

Keywords

Proton pump inhibitors, Inapproperiate use, self-treating, adverse effects

Abstract

One of the most often prescribed medications is PPIs (proton pump inhibitors). Because of an increase in proton pump inhibitors that may be purchased without a prescription, their use is probably even higher than previously thought. Regrettably, Proton pump inhibitors are frequently used off-label for prolonged durations of time. In the last two decades, there has been an upsurge in the use of PPIs, raising concerns about their potential side effects. Numerous research have looked into the connection between infection and PPI use, notably pneumonia and Clostridium difficile. It is hypothesized that PPI use alters the gastrointestinal microbiota, which creates an environment that is favorable for the growth of these infections. It has been reported by at least one study that dementia risk may be increased by long-term PPI use. When prescribing any medication, drug interactions are a crucial but frequently ignored factor. One of the latest concerns about the use of PPI is its role in progression or development of chronic renal disease.
Thus, This study's aim was to evaluate the prevelance of improper use of proton pump inhibitors and to estimate the link between the use of PPI and its associated severe side effects given growing worries regarding PPI misuse in the general population.
Methodology and Study design: This study is a questionnaire-based descriptive study, carried out from November 2021 to April 2022, the data collected from 406 individuals (83 males and 323 females), average of age (6-58) who were taken any type of PPI or not taken any one in Basrah city, the second questionnaire was specific for pharmacist in Basra (71) which composed (12) questions. The ethics committee of college of pharmacy university of Basrah approved the protocol.
Result: The questionnaire was collect and responses of 406 participant were analyzed 196(48.3%) of them wrere used PPI, most of them 153(78.1%)were females.Also the large number of PPI user 171(87.2%)were unhealthy with different comorbid illnesses. omeprazole was the most popular choice among the study's participants, took by 110 (56.1%). 77 (39.3%), 21(29.6%) were taken their treatment by Physician prescription as shown on individual and pharmacist questionnaire respectively, and 54 (27.6%), 21(29.6%) treated by pharmacist prescription. In addition the results showed large number of participants were on self-treating without prescription 44 (22.4%), 29(40.8%) as shown on individual and pharmacist questionnaire respectively. Headaches affected about 30 (15.3%) of PPI user participants, and nausea affected about 40 (20.4%). In addition to 27 (13.8%) cases of abdominal pain, 30 (15.3%) cases of constipation, 20 (10.2%) cases of diarrhea, 5 (2.6%) cases of skin rash, and13 (6.6%) cases of muscle spasm and arrhythmia. In addition, some participants have kidney illness 10 (5.1%) or hematuria (2, 1%)and (2, 1%) bone fruture however 111 (56.6%), of them do not have any symptoms.
Conclusion: It's necessary to carefully balance the benefits and risks of long-term PPI use, notably in young patients, whose treated with these drugs may continue for many years. Although these medications have a number of known system-related side effects, for most patients with appropriate short-term causes, PPIs' benefits are expected to outweigh their dangers.

Abstract 278 | pdf Downloads 140

References

1. Rababa M. Proton pump inhibitors and the prescribing cascade. J. Gerontol. Nurs. 2015;42(4):23–31. [PubMed] [Google Scholar]
2. Batuwitage BT, Kingham JGC, Morgan NE, et al. Inappropriate prescribing of proton pump inhibitors in primary care. Postgrad Med J 2007; 83: 66–68.
3. Gawron AJ, Feinglass J, Pandolfino JE, Tan BK, Bove MJ, Shintani-Smith S. Brand name and generic proton pump inhibitor prescriptions in the United States: insights from the national ambulatory medical care survey (2006-2010) Gastroenterol Res Pract. 2015;2015:1–7. [PMC free article] [PubMed] [Google Scholar]
4. Heidelbaugh JJ, Kim AH, Chang R, Walker PC. Overutilization of proton-pump inhibitors: what the clinician needs to know.. Therap Adv Gastroenterol. 2012;5:219–232. [PMC free article] [PubMed] [Google Scholar]
5. Fallingborg J. Intraluminal pH of the human gastrointestinal tract. Danish medical bulletin. 1999 Jun;46(3):183–196. [PubMed] [Google Scholar]
6. Fontes-Carvalho R and Albuquerque A. Clopidogrel–proton pump inhibitors drug interaction: implications to clinical practice. Rev Port Cardiol 2010; 29: 1555–1567.
7. Maes M.L., Fixen D.R., Linnebur S.A. Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence. Therap. Adv. Drug Safety. 2017;8(9):273–297. [PMC free article] [PubMed] [Google Scholar
8. Freedberg DE, Salmasian H, Friedman C, et al. Proton pump inhibitors and risk for recurrent Clostridium difficile infection among inpatients. Am J Gastroenterol 2013; 108: 1794–1801.
9. Arai N, Nakamizo T, Ihara H, et al. Histamine H2-blocker and proton pump inhibitor use and the risk of pneumonia in acute stroke: a retrospective analysis on susceptible patients. PLoS One 2017; 12(1): e0169300.
10. Xie Y, Bowe B, Li T, et al. Long-term kidney outcomes among users of proton pump inhibitors without intervening acute kidney injury. Kidney Int 2017; 91(6): 1482–1494
11. Targownik LE, Leslie WD, Davison KS, et al; CaMos Research Group. The relationship between proton pump inhibitor use and longitudinal change in bone mineral density: a population-based from the Canadian Multicentre Osteoporosis Study (CaMos). Am J Gastroenterol 2012;107:1361–1369.
12. Luo H, Fan Q, Xiao S, Chen K. Changes in proton pump inhibitor prescribing trend over the past decade and pharmacists' effect on prescribing practice at a tertiary hospital. BMC Health Serv Res. 2018;18:537. [PMC free article] [PubMed] [Google Scholar]
13. Lee C, Lo A, Ubhi K, Milewski M. Outcome after discontinuation of proton pump inhibitors at a residential care site: quality improvement project. Can J Hosp Pharm. 2017;70:215–223. [PMC free article] [PubMed] [Google Scholar]
14. Heidelbaugh JJ, Goldberg KL, Inadomi JM. Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. Am J Manag Care. 2010;16:228–234. [PubMed] [Google Scholar]
15. Björnsson E, Abrahamsson H, Simrén M, et al. Discontinuation of proton pump inhibitors in patients on long-term therapy: a double-blind, placebo-controlled trial.. Aliment Pharmacol Ther. 2006;24:945–954. [PubMed] [Google Scholar]
16. Murie J, Allen J, Simmonds R, de Wet C. Glad you brought it up: a patient-centred programme to reduce proton-pump inhibitor prescribing in general medical practice. Qual Prim Care. 2012;20:141–148. [PubMed] [Google Scholar]
17. Reimer C, Bytzer P. Discontinuation of long-term proton pump inhibitor therapy in primary care patients: a randomized placebo-controlled trial in patients with symptom relapse. Eur J Gastroenterol Hepatol. 2010;22:1182–1188. [PubMed] [Google Scholar]
18. Zwisler JE, Jarbøl DE, Lassen AT, Kragstrup J, Thorsgaard N, Schaffalitzky de Muckadell OB. Placebo-controlled discontinuation of long-term acid-suppressant therapy: a randomised trial in general practice. Int J Family Med. 2015;2015:1–7. [PMC free article] [PubMed] [Google Scholar]
19. Inadomi JM, Jamal R, Murata GH, et al. Step-down management of gastroesophageal reflux disease. Gastroenterology. 2001;121:1095–1100. [PubMed] [Google Scholar
20. Rebekah A. Wahking,Randal L. Steele (2018) Outcomes From a Pharmacist – led Proton Pump Inhibitor Stewardship Program at a Single Institution Hospital Pharmacy, Vol. 53(1)
21. Brandhagen, DJ , Pheley, AM , Onstad, GR , Freeman, ML , Lurie, N . Omeprazole use at an urban county teaching hospital. J Gen Intern Med 1995;10:513–15. Google Scholar | Crossref
22. Kelly O.B. The inappropriate prescription of oral proton pump inhibitors in the hospital setting: a prospective cross-sectional study. Dig. Dis. Sci. 2015;60(8):2280–2286. [PubMed] [Google Scholar
23. Huang TC and Lee CL: Diagnosis, treatment, and outcome in patients with bleeding peptic ulcers and Helicobacter pylori infections. Biomed Res Int. 2014:6581082014. View Article : Google Scholar : PubMed/NCBI
24. Chitwood K., Carlson A., Zhang D. Perspectives on empiric and chronic proton pump inhibitor therapy. Formulary. 2004;39(8):406. [Google Scholar]
25. Bajaj J.S. Association of proton pump inhibitor therapy with spontaneous bacterial peritonitis in cirrhotic patients with ascites. Am. J. Gastroenterol. 2009;104(5):1130–1134. [PubMed] [Google Scholar]
26. Dial S. Use of gastric acid–suppressive agents and the risk of community-acquired Clostridium difficile–associated disease. Jama. 2005;294(23):2989–2995. [PubMed] [Google Scholar]
27. Habu Y. “Proton-pump inhibitor-first” strategy versus “step-up” strategy for the acute treatment of reflux esophagitis: a cost-effectiveness analysis in Japan. J. Gastroenterol. 2005;40(11):1029–1035. [PubMed] [Google Scholar]
28. Freigofas J. Indirect evidence for proton pump inhibitor failure in patients taking them independent of meals. Pharmacoepidemiol. Drug Saf. 2014;23(7):768–772. [PubMed] [Google Scholar]
29. Gómez-Torrijos E. The efficacy of step-down therapy in adult patients with proton pump
inhibitor-responsive oesophageal eosinophilia. Aliment. Pharmacol. Ther. 2016;43(4):534–540. [PubMed] [Google Scholar
30. Wolfe MM, Soll AH. The physiology of gastric acid secretion. N Engl J Med 1988;319:1707-15. CrossRefPubMedWeb of ScienceGoogle Scholar
31. Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 2006;296:2947-53. CrossRefPubMedWeb of ScienceGoogle Scholar
32. Reynolds PM, MacLaren R. Re-evaluating the utility of stress ulcer prophylaxis in the critically ill patient: a clinical scenario-based meta-analysis. Pharmacotherapy. 2018. https://doi.org/10.1002/phar.2172.
33. Toews I, George AT, Peter JV, Kirubakaran R, Fontes LES, Ezekiel JPB, et al. Interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units. Cochrane Database Syst Rev. 2018;6:CD008687.
34. Chitwood K., Carlson A., Zhang D. Perspectives on empiric and chronic proton pump inhibitor therapy. Formulary. 2004;39(8):406. [Google Scholar]
35. Bajaj J.S. Association of proton pump inhibitor therapy with spontaneous bacterial peritonitis in cirrhotic patients with ascites. Am. J. Gastroenterol. 2009;104(5):11301134. [PubMed] [Google Scholar
36. Mat Saad, AZ , Collins, N , Lobo, MM , O'Connor, HJ . Proton pump inhibitors: a survey of prescribing in an Irish general hospital. Int J Clin Pract 2005;59:31–4. Google Scholar | Crossref
37. Walker, NM , McDonald, J . An evaluation of the use of proton pump inhibitors. Pharm World Sci 2001;23:116–17. Google Scholar | Crossref
38. Griffin, SM , Raimes, SA . Proton pump inhibitors may mask early gastric cancer. Dyspeptic patients over 45 should undergo endoscopy before these drugs are started. BMJ 1998;317:1606–7. Google Scholar | Crossref