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Adverse Effects of Proton Pump Inhibitors—Evidence and Plausibility
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Problems Associated with Deprescribing of Proton Pump Inhibitors

1
Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
2
Division of Gastroenterology and Hepatology, The National University Hospital of Iceland, 101 Reykjavik, Iceland
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2019, 20(21), 5469; https://doi.org/10.3390/ijms20215469
Received: 18 September 2019 / Revised: 24 October 2019 / Accepted: 28 October 2019 / Published: 2 November 2019
(This article belongs to the Special Issue Proton-Pump Inhibitors (PPIs))
Proton pump inhibitors (PPIs) are recommended as a first-line treatment for gastroesophageal reflux disease (GERD) and other acid related disorders. In recent years, concerns have been raised about the increasing prevalence of patients on long-term PPI therapy and inappropriate PPI use. It is well known that short-term PPI therapy is generally well tolerated and safe; however, their extensive long-term use is a major global issue. One of these long-standing concerns is PPI-induced gastrin elevation secondary to hypoacidity. Hypergastrinemia is believed to play a role in rebound hyperacidity when PPIs are discontinued resulting in induced dyspeptic symptoms that might result in the reinstitution of therapy. Gastrin exerts tropic effects in the stomach, especially on enterochromaffin-like (ECL) cells, and concerns have also been raised regarding the potential progression to dysplasia or tumor formation following long-term therapy. It is well known that a substantial number of patients on long-term PPI therapy can discontinue PPIs without recurrence of symptoms in deprescribing trials. What is unknown is how sustainable deprescribing should be undertaken in practice and how effective it is in terms of reducing long-term outcomes like adverse drug events, morbidity and mortality. Moreover, there is no clear consensus on when and how deprescribing strategies should be attempted in practice. This review sought to summarize the harms and benefits of long-term PPI therapy with special focus on gastrin elevation and its relation to deprescribing studies and future interventions that may improve PPI use. View Full-Text
Keywords: proton pump inhibitors; gastrin; rebound acid hypersecretion; deprescribing; step-down; tapering; on-demand; discontinuation proton pump inhibitors; gastrin; rebound acid hypersecretion; deprescribing; step-down; tapering; on-demand; discontinuation
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Helgadottir, H.; Bjornsson, E.S. Problems Associated with Deprescribing of Proton Pump Inhibitors. Int. J. Mol. Sci. 2019, 20, 5469.

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