McMaster Textbook of Internal Medicine

McMaster Textbook of Internal Medicine
Interviews
Gastroenterology
Indications for long-term PPI treatment

Indications for long-term PPI treatment

2019-02-15

Paul Moayyedi

Recorded at the 4th McMaster International Review Course in Internal Medicine (MIRCIM).

What are the indications for long-term treatment with proton pump inhibitors (PPIs)?

Paul Moayyedi, MB ChB, PhD: There is a number of indications. Perhaps the one where it is most effective is reflux esophagitis where you do an endoscopy and you show a break in the lining of the mucosa. In such situations PPIs are very effective, with the number needed to treat of almost 1. Having said that, if you stop the PPI and assess it, the patients nearly always have a relapse, so the recommendation is to continue.

Following on from that would be heartburn where you do not know for sure they have reflux esophagitis but again it is reasonable to give a PPI. There is also functional dyspepsia where the main symptom is epigastric pain. Randomized trials do show PPIs are effective in that condition. Rarely, Helicobacter pylori–negative peptic ulcer disease would be a condition in which patients ought to have long-term PPI therapy. There is a number of other conditions, like noncardiac chest pain, or prophylaxis because the person has a high risk of gastrointestinal bleed. Those would be the main indications for a long-term PPI use.

PPIs are also used in H pylori eradication therapy but that is usually only for 2 weeks.

See also

Confirming chronic pancreatitis Which pancreatic function tests should be performed to establish the diagnosis of chronic pancreatitis?
Current management of Clostridium difficile infection A lecture by Dr Christine Lee, from McMaster University, Canada, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Duration of treatment with high-dose PPIs in GERD What should be the duration of high-dose proton pump inhibitor (PPI) treatment in a patient with gastroesophageal reflux disease?
How to manage incidental pancreatic cysts in an evidence-based era A lecture by Dr Paul Moayyedi, from McMaster University, Canada, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Current management of dyspepsia A lecture by Dr Paul Moayyedi, from McMaster University, Canada, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
H pylori eradication before long-term PPI therapy Should Helicobacter pylori be eradicated before a long-term treatment with proton pump inhibitors (PPIs) is started?
Evaluating H pylori eradication When should we check if Helicobacter pylori eradication therapy was successful? In particular, should we do it in patients with dyspepsia?
Microbiome: Fecal transplant in Clostridium difficile and ulcerative colitis Prof. Moayyedi introduces the idea of fecal transplants and explains the role the microbiome may play in treating ulcerative colitis.

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