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Proton pompa inhibitörlerini ne kadar doğru kullanıyoruz? Tek merkez deneyimi

Yıl 2025, Cilt: 24 Sayı: 1, 35 - 40, 29.04.2025
https://doi.org/10.17941/agd.1684056

Öz

Giriş ve Amaç: Proton pompa inhibitörleri, gastrik asit sekresyonunu etkili bir şekilde bloke eden ilaçlardır. Tüm dünyada kullanımları artmaktadır. Bununla birlikte, gereksiz ve endikasyon dışı proton pompa inhibitörü kullanımının da ciddi şekilde arttığı gözlemlenmektedir. Bu çalışmanın amacı, proton pompa inhibitörleri kullanımının uygunluğunu değerlendirmektir. Gereç ve Yöntem: Bu çalışma, tek merkezli ve kesitsel bir gözlem çalışması olarak gerçekleştirilmiştir. 10 Mart 2022- 10 Nisan 2022 tarihleri arasında Mersin Üniversitesi Tıp Fakültesi Gastroenteroloji Kliniğine yatırılan hastalar incelendi. Hastaların yatış nedenleri, demografik verileri, yatış öncesi ve sonrası ilaç kullanımları klinik ekibi çalışmanın farkında olmadan kaydedildi. Bulgular: Çalışma döneminde 106 hasta kliniğe yatırıldı. Hastaların %53'ü erkek olup, yaş ortalaması 65.8 yıl idi. Yatış nedenleri arasında en sık görülenler gastrointestinal sistem kanaması, akut pankreatit ve karın ağrısı etiyolojisi araştırılması olarak belirlendi. Yatan hastaların 45’i (%42) evde proton pompa inhibitörleri kullanırken bunların 24’ünde (%53) uygun endikasyon vardı. Hastanede yatış sırasında proton pompa inhibitörleri kullanan 92 (%86.7) hastanın ise 41’inde (%44.6) proton pompa inhibitörleri kullanımı endikasyona uygundu. Sonuç: Proton pompa inhibitörleri asit ile ilişkili hastalıkların tedavisinde temel ilaçlar arasında yer almakta ve düşük yan etki profilleri sayesinde yaygın olarak kullanılmaktadır. Ancak, bu durum gereksiz kullanım riskini de beraberinde getirmektedir. Az da olsa ciddi yan etkiler, mali yük ve polifarmasi gibi dezavantajların önemi çalışmalar ile vurgulanmalıdır.

Kaynakça

  • 1-Farley A, Wruble LD, Humphries TJ. Rabeprazole versus ranitidine for the treatment of erosive gastroesophageal reflux disease: A double-blind, randomized clinical trial. Am J Gastroenterology. 2000;95(8):1894-9.
  • 2- Wolfe M, Sachs G. Acid suppression: Optimizing therapy for gastroduodenal ulcer healing, gastroesophageal reflux disease, and stress-related erosive syndrome. Gastroenterology. 2000;118(2 Suppl 1):S9-31.
  • 3- Shi S, Klotz U. Proton pump inhibitors: an update of their clinical use and pharmacokinetics. Eur J Clin Pharmacol. 2008;64(10):935-51.
  • 4- Lassen AT. Acid-related disorders and use of antisecretory medication. Dan Med Bull. 2007;54(1):18-30.
  • 5- Chiba N, De Gara C, Wilkinson J, Hunt R. Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: A meta-analysis. Gastroenterology. 1997;112(6):1798-810.
  • 6- Hussain S, Stefan M, Visintainer P, Rothberg M. Why Do Physicians Prescribe Stress Ulcer Prophylaxis to General Medicine Patients?. Southern Medical Journal. 2010;103(11):1103-10.
  • 7- Ksiądzyna D, Szeląg A, Paradowski L. Overuse of proton pump inhibitors. Pol Arch Med Wewn. 2015;125(4):289-98.
  • 8- Ntaios G, Chatzinikolaou A, Kaiafa G, Savopoulos C, Hatzitolios A, Karamitsos D. Evaluation of use of proton pump inhibitors in Greece. Eur J Intern Med. 2009;20(2):171-3.
  • 9- Walker NM, McDonald J. An evaluation of the use of proton pump inhibitors. Pharm World Sci. 2001 Jun;23(3):116-7.
  • 10- Sebastian S, Kernan N, Qasim A, O’Morain C, Buckley M. Appropriateness of gastric antisecretory therapy in hospital practice. Ir J Med Sci. 2003;172(3):115-7.
  • 11- Parente F, Cucino C, Gallus S, et al. Hospital use of acid‐suppressive medications and its fall‐out on prescribing in general practice: a 1‐month survey. Aliment Pharmacol Ther. 2003;17(12):1503-6.
  • 12- Heidelbaugh JJ, Goldberg KL, Inadomi JM. Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. Am J Manag Care. 2010;16(9):e228-34.
  • 13- Sheen E, Triadafilopoulos G. Adverse Effects of Long-Term Proton Pump Inhibitor Therapy. Dig Dis Sci. 2011;56(4):931-50.
  • 14- Savarino V, Dulbecco P, Savarino E. Are proton pump inhibitors really so dangerous? Dig Liver Dis. 2016;48(8):851-9.
  • 15- Fossmark R, Johnsen G, Johanessen E, Waldum HL. Rebound acid hypersecretion after long‐term inhibition of gastric acid secretion. Aliment Pharmacol Ther. 2005;21(2):149-54.
  • 16- Metz DC, Pilmer BL, Han C, Perez MC. Withdrawing PPI therapy after healing esophagitis does not worsen symptoms or cause persistent hypergastrinemia: analysis of dexlansoprazole MR clinical trial data. Am J Gastroenterol. 2011;106(11):1953-60.
  • 17- Nardino RJ, Vender RJ, Herbert PN. Overuse of acid-suppressive therapy in hospitalized patients1. Am J Gastroenterology. 2000;95(11):3118-22.
  • 18- Eid SM, Boueiz A, Paranji S, Mativo C, BA RL, Abougergi MS. Patterns and Predictors of Proton Pump Inhibitor Overuse among Academic and Non-Academic Hospitalists. Intern Med. 2010;49(23):2561-8.
  • 19- Heidelbaugh JJ, Inadomi JM. Magnitude and Economic Impact of Inappropriate Use of Stress Ulcer Prophylaxis in Non-ICU Hospitalized Patients. Am J Gastroenterology. 2006;101(10):2200-5.

The appropriate use of proton pump inhibitors: Single centre experience

Yıl 2025, Cilt: 24 Sayı: 1, 35 - 40, 29.04.2025
https://doi.org/10.17941/agd.1684056

Öz

Bacground and Aims: Proton pump inhibitors are a class of pharmaceuticals that effectively inhibit gastric acid secretion. Their utilisation is increasing on a global scale. However, the use of proton pump inhibitors for off-label and unnecessary indications has also increased significantly. The aim of this study was to evaluate the appropriateness of proton pump inhibitor use. Materials and Methods: This study was conducted as a single-centre, cross-sectional observational study. Between 10 March 2022 and 10 April 2022, patients admitted to the Gastroenterology Clinic of Mersin University Faculty of Medicine were examined. The reasons for hospitalisation, demographic data, and pre- and post-hospitalisation drug use of the patients were recorded without the clinical team being aware of the study. Results: During the study period, 106 patients were hospitalised in the clinic, with 53% of the patients being male and the mean age being 65.8 years. The most common reasons for hospitalisation were gastrointestinal bleeding, acute pancreatitis and abdominal pain. While 45 (42%) of the hospitalised patients used proton pump inhibitors at home, 24 (53%) of them had appropriate indication. Of the 92 (86.7%) patients who used proton pump inhibitors during hospitalisation, 41 (44.6%) had appropriate indication. Conclusion: Proton pump inhibitors represent a class of pharmaceutical agents commonly prescribed for the management of acid-related pathologies, characterised by their favourable safety profile and broad accessibility. However, this widespread utilisation carries inherent risks, including the potential for inappropriate prescriptions. It is imperative to underscore the significance of potential drawbacks, such as adverse effects of a minor severity, financial implications and the necessity for polypharmacy, as highlighted in extant research.

Kaynakça

  • 1-Farley A, Wruble LD, Humphries TJ. Rabeprazole versus ranitidine for the treatment of erosive gastroesophageal reflux disease: A double-blind, randomized clinical trial. Am J Gastroenterology. 2000;95(8):1894-9.
  • 2- Wolfe M, Sachs G. Acid suppression: Optimizing therapy for gastroduodenal ulcer healing, gastroesophageal reflux disease, and stress-related erosive syndrome. Gastroenterology. 2000;118(2 Suppl 1):S9-31.
  • 3- Shi S, Klotz U. Proton pump inhibitors: an update of their clinical use and pharmacokinetics. Eur J Clin Pharmacol. 2008;64(10):935-51.
  • 4- Lassen AT. Acid-related disorders and use of antisecretory medication. Dan Med Bull. 2007;54(1):18-30.
  • 5- Chiba N, De Gara C, Wilkinson J, Hunt R. Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: A meta-analysis. Gastroenterology. 1997;112(6):1798-810.
  • 6- Hussain S, Stefan M, Visintainer P, Rothberg M. Why Do Physicians Prescribe Stress Ulcer Prophylaxis to General Medicine Patients?. Southern Medical Journal. 2010;103(11):1103-10.
  • 7- Ksiądzyna D, Szeląg A, Paradowski L. Overuse of proton pump inhibitors. Pol Arch Med Wewn. 2015;125(4):289-98.
  • 8- Ntaios G, Chatzinikolaou A, Kaiafa G, Savopoulos C, Hatzitolios A, Karamitsos D. Evaluation of use of proton pump inhibitors in Greece. Eur J Intern Med. 2009;20(2):171-3.
  • 9- Walker NM, McDonald J. An evaluation of the use of proton pump inhibitors. Pharm World Sci. 2001 Jun;23(3):116-7.
  • 10- Sebastian S, Kernan N, Qasim A, O’Morain C, Buckley M. Appropriateness of gastric antisecretory therapy in hospital practice. Ir J Med Sci. 2003;172(3):115-7.
  • 11- Parente F, Cucino C, Gallus S, et al. Hospital use of acid‐suppressive medications and its fall‐out on prescribing in general practice: a 1‐month survey. Aliment Pharmacol Ther. 2003;17(12):1503-6.
  • 12- Heidelbaugh JJ, Goldberg KL, Inadomi JM. Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. Am J Manag Care. 2010;16(9):e228-34.
  • 13- Sheen E, Triadafilopoulos G. Adverse Effects of Long-Term Proton Pump Inhibitor Therapy. Dig Dis Sci. 2011;56(4):931-50.
  • 14- Savarino V, Dulbecco P, Savarino E. Are proton pump inhibitors really so dangerous? Dig Liver Dis. 2016;48(8):851-9.
  • 15- Fossmark R, Johnsen G, Johanessen E, Waldum HL. Rebound acid hypersecretion after long‐term inhibition of gastric acid secretion. Aliment Pharmacol Ther. 2005;21(2):149-54.
  • 16- Metz DC, Pilmer BL, Han C, Perez MC. Withdrawing PPI therapy after healing esophagitis does not worsen symptoms or cause persistent hypergastrinemia: analysis of dexlansoprazole MR clinical trial data. Am J Gastroenterol. 2011;106(11):1953-60.
  • 17- Nardino RJ, Vender RJ, Herbert PN. Overuse of acid-suppressive therapy in hospitalized patients1. Am J Gastroenterology. 2000;95(11):3118-22.
  • 18- Eid SM, Boueiz A, Paranji S, Mativo C, BA RL, Abougergi MS. Patterns and Predictors of Proton Pump Inhibitor Overuse among Academic and Non-Academic Hospitalists. Intern Med. 2010;49(23):2561-8.
  • 19- Heidelbaugh JJ, Inadomi JM. Magnitude and Economic Impact of Inappropriate Use of Stress Ulcer Prophylaxis in Non-ICU Hospitalized Patients. Am J Gastroenterology. 2006;101(10):2200-5.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Gastroenteroloji ve Hepatoloji
Bölüm Makaleler
Yazarlar

Orhan Sezgin 0000-0002-6704-4716

Hasan Yardımcı 0000-0001-9166-706X

Yayımlanma Tarihi 29 Nisan 2025
Gönderilme Tarihi 30 Eylül 2024
Kabul Tarihi 23 Mart 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 24 Sayı: 1

Kaynak Göster

APA Sezgin, O., & Yardımcı, H. (2025). The appropriate use of proton pump inhibitors: Single centre experience. Akademik Gastroenteroloji Dergisi, 24(1), 35-40. https://doi.org/10.17941/agd.1684056

test-5