The American Gastroenterological Association has released a new Clinical Practice Update providing best practice advice on how to approach de-prescribing proton pump inhibitors (PPI) in ambulatory patients. See the AGA website information here.
As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after receiving a once-daily proton pump inhibitor (PPI) therapy. A recent study by Jason Abdallah and colleagues at MetroHealth Medical Center, Case Western Reserve University School of Medicine, utilized survey, pH, and other data. Although a small trial, the findings showed
A recent article shows patient safety concerns about PPI’s are common and strongly associated with attempts at discontinuation, with or without a provider’s recommendation. Patients at high risk for GI bleeding, who clearly benefit from PPI’s, were just as likely to have tried stopping PPI’s as others. Physicians should always discuss the risks and benefits
No single test identifies reflux as the etiology for extra-esophageal symptoms.
It is well recognized that reflux can be causal in subgroups of patients with chest and ENT symptoms like asthma, cough, hoarseness, sore throat, sinusitis, and ear pain. However, the possibility of reflux as the cause for a variety of ENT symptoms is both overestimated and often abused. In fact, the cause of extraesophageal symptoms
Proton pump inhibitor therapy is not connected to an increased risk of cardiovascular disease, according to a study published in Alimentary Pharmacology & Therapeutics. The FDA has discouraged using PPI’s with antiplatelet therapy clopidogrel because the drugs work with the same isoenzyme. “Inhibition of CYP2C19 by PPIs may reduce the bioavailability of the active metabolites of
GERD affects 10% to 20% of adults in Western populations and has been known to be an increased risk factor for esophageal adenocarcinoma. Research on the association between antireflux medication or surgery and risk for esophageal adenocarcinoma has remained limited, although the typical approach has been to treat reflux aggressively when there are precancerous changes like
From the AGA website, here is a nice review of the data thus far and how to alleviate your patients’ concerns. See the AGA review here.
A recent study in the Annals of Internal Medicine found people who consumed very hot tea and alcohol every day had a fivefold higher risk of esophageal cancer, compared with those who drank tea less than once per week and consumed less than 15 grams of alcohol daily. People who drank very hot tea daily
According to a study published online Dec. 21 in JAMA Otolaryngology-Head & Neck Surgery, data for 13,805 patients aged 66 and older found that gastroesophageal reflux disease was linked to an increased risk of malignancy of the larynx, oropharynx, hypopharynx, tonsil, nasopharynx and paranasal sinuses. “GERD is associated with the presence of malignancy of the (upper aerodigestive
A study in The American Journal of Gastroenterology found that people who did not get heartburn symptom relief from standard treatments but did not have detectable reflux tended to experience more distress and have a poorer quality of life, while symptoms for those with diagnosed gastroesophageal reflux disease who did not respond to proton
