Long Term Acid Suppressant Medications (ppi’s): Concerns and Care
- Risk of infectious complications – including Pneumonias, Cl difficile diarrhoeas
- Malabsorption of Iron, Vitamin B12, Magnesium and Metabolic bone disease
- Hypergastrinemia, Gastric carcinoids and Atrophic Gastritis
Other concerns include acute interstitial nephritis (kidney disease) and drug interactions particularly reducing the effect of Clopidogrel, which is used in coronary stented patients to reduce the risk of stent blockage.
InfectionsA concern with any form of gastric acid inhibition is an increased risk of enteric infections since gastric acid normally protects against these infections. In addition, a reduction in gastric acid secretion permits bacteria to more easily colonize the upper gastrointestinal tract, which may predispose to pneumonia.
Clostridium difficile and other enteric infectionsThe best documented association of PPI use with enteric infections has been with C. difficile diarrhea, even in patients not exposed to antibiotics(1-7). C. difficile is an anaerobic organism that sporulates; acid-resistant spores are presumed to be the major vector of disease transmission. Three meta-analyses of observational studies have demonstrated an increased risk of C. difficile infections in patients treated with PPIs(8-10). A 2012 meta-analysis of 42 observational studies that included 313,000 patients found that PPI use was significantly associated with an increased risk of both incident and recurrent C. difficile infection(9). best portable fire pump