title: When is proton pump inhibitor use appropriate?
abstract: Proton pump inhibitor (PPI) therapy is commonly used outside of Food and Drug Administration indication for a broad range of conditions such as extra-esophageal reflux and PPI-responsive esophageal eosinophilia. While this may be appropriate in some scenarios, it has also resulted in widespread inappropriate PPI use. At the same time, data suggesting adverse effects of long-term PPI therapy are multiplying, albeit mainly from low quality studies. The systematic review by Scarpignato et al. (BMC Med 14:179, 2016) addresses this dilemma with a comprehensive analysis of the risks and benefits of PPI use. The authors concluded that, while PPIs are highly efficacious in erosive acid-peptic disorders, efficacy is not equaled in other conditions. In some instances, they found no supportive evidence of benefit. With respect to side effects, they indicated that the questionable harms associated with PPI therapy do not outweigh the benefits afforded by appropriate PPI use. However, inappropriate PPI use results in increased healthcare costs and unnecessary exposure to potential adverse effects. Ideally, PPI therapy should be personalized, based on indication, effectiveness, patient preference, and risk assessment.Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0718-z .
authors.affiliation: Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Rena
authors.initials: R
authors.lastname: Yadlapati
authors.affiliation: Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. p-kahrilas@northwestern.edu.|Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Feinberg School of Medicine, 676 N. St. Clair Street, 14th Floor, Chicago, IL, 60611, USA. p-kahrilas@northwestern.edu.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
mesh_terms: D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006801:Humans; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*
chemical_list: D054328:Proton Pump Inhibitors
keywords: Gastroesophageal reflux disease; Indication; Proton pump inhibitors