Proton pump inhibitors: a round up of the latest literature

Proton pump inhibitors (PPIs) are commonly prescribed for the older person to treat acid-related conditions, including gastro-oesophageal reflux disorders, duodenal and gastric ulcers and eradication of helicobacter pylori. PPIs such as omeprazole and lansoprazole have many therapeutic benefits, but are not without risk. This research roundup will consider common adverse events experienced by the elderly when prescribed PPIs (Maes et al, 2017); an evaluation of methods to assess potentially inappropriate medicines, including PPIs (Sakr et al, 2018); and perspectives of patients and clinicians on conversations about their continued use (Thompson et al, 2018; Turner et al, 2018).

This article is a review of the literature, conducted by researchers in the USA (Maes et al, 2017). They reviewed published cohort studies, case controlled studies, randomised controlled trials and meta-analyses related to the older person (defined as people aged over 60 years). Six groups of adverse events were reported across 58 studies, namely bone fractures and falls (n=18), clostridium difficile infection (n=13), pneumonia (n=10), vitamin B12 deficiency (n=7), kidney disease (n=7) and dementia (n=4). Increased risk of bone fracture and falls appears to be one of the most commonly reported adverse events that led to recommendations that treatment should be as short as possible. The mechanism of action for this adverse event is not clear, but may be as a result of impaired calcium absorption, decreased bone density or higher risk of falls while using PPIs. It was also reported that older people who were prescribed PPIs may be at a greater risk of clostridium difficile infection due to an increase in gastric pH. Associations between use of PPIs and pneumonia were inconclusive, but the authors suggested that further research in this area was needed. A causal relationship between vitamin b12 deficiency and long-term PPI use has been reported, but associations between PPIs, kidney disease and dementia is less clear. This review has provided some insight into the risks and adverse events associated with long-term PPI use but, due to the observational nature of studies included, causal links cannot be made. Nonetheless, to reduce risk, the authors recommend that regular medication reviews should be conducted to evaluate the need for continued use of PPIs in the older person.