Best Practice Advice Released on Long-Term Use of Proton Pump Inhibitors

The American Gastroenterological Association (AGA) has released best practice advice for long-term use of proton pump inhibitors (PPIs).

From 1999 to 2012, long-term use of PPIs for the treatment of gastroesophageal reflux disease (GERD), Barrett’s esophagus, and nonsteroidal anti-inflammatory drug (NSAID) bleeding prophylaxis doubled in the United States. During the same period, studies showed that the number of adverse events doubled.

Based on expert opinion and appropriate publications, the AGA provided best practice advice for PPIs-used. The practice advice was published inGastroenterology.

1. Patients with GERD and acid-related complications should take a PPI for short-term healing, maintenance of healing, and long-term symptom control.

2. Patients with uncomplicated GERD who were responsive to short-term PPIs should subsequently attempt to stop or reduce their use. Patients who are unable to reduce PPI use should consider ambulatory esophageal pH/impedance monitoring to distinguish GERD from a functional syndrome before committing to lifelong PPIs.

3. Patients with symptomatic GERD and Barrett’s esophagus should consider long-term PPIs.

4. Asymptomatic patients with Barrett’s esophagus should consider a long-term PPI.

5. Patients at high risk for ulcer-related bleeding from NSAIDs should take a PPI if they continue using NSAIDs.

6. The dosage of long-term PPI use should be reevaluated periodically to ensure that the lowest effective PPI dose can be prescribed.

7. Patients who take PPIs long term should not routinely screen or monitor bone mineral density, serum creatinine, magnesium, or vitamin B12.

8. Specific PPI formulations should not be selected based on potential risks.

Health care professionals should converse with their patients to help them understand the importance of properPPI use.