Doctors prescribing proton pump inhibitors for conditions such as dyspepsia should be aware of the risks associated with this class of medications and weigh them carefully against the likely benefits, a series of studies has suggested.
One of the studies, all published in the Archives of Internal Medicine, analysed fracture rates among participants in the Women’s Health Initiative. Although PPIs were not associated with any change in bone mineral density or hip fractures, there was a link with increased spine, forearm and wrist fractures, and total fractures.
Another study, reviewing more than 100,000 patients discharged from hospital, found a 74 per cent increase in hospital-acquired Clostridium difficile infections among those taking PPIs. A third study identified a 42 per cent higher recurrence of C. difficile associated with the medication.
A meta-analysis of seven randomised trials concluded that increasing PPI doses in patients with bleeding ulcers was not likely to be productive: it did not reduce the rate of additional bleeding, the number of surgical interventions required or mortality. An editorial noted that PPIs were very effective for oesophageal inflammation, gastro-oesophageal reflux and ulcers, but the majority of prescriptions were for non-ulcer dyspepsia.
Arch Intern Med., 2010;170:747-748, 765-771, 751-758, 772-778, 784-790, 779-783, 749-750
About Greg Baxter
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