PPIs in patients receiving oral glucocorticoids

Should proton pump inhibitors (PPIs) be prescribed in patients treated with oral glucocorticoids?

Paul Moayyedi, MB ChB, PhD: Not with corticosteroids. They do not need to be prescribed with those at all. It is very rare you would need to do that because corticosteroids have a very low risk of developing ulcer disease. That has been overplayed in the literature.

Nonsteroidal anti-inflammatory drugs (NSAIDs) do increase the risk of peptic ulcer disease, but you should only use PPIs as prophylaxis in select cases: patients at high risk of bleeding. Those would usually be patients aged over 65 years with one other risk factor such as previous history of ulcer or maybe they are taking aspirin plus, as traditionally, an NSAID and the risk increases a lot. Similarly, if they are on an anticoagulant plus an NSAID, then you might well prescribe PPIs as prophylaxis, but again, only in those at high risk of serious consequences of gastrointestinal bleeding, such as those over 65 years.

A young person taking nonsteroidals for pain in their knee—there is no need to take a PPI, unless, of course, symptoms develop while they are taking a nonsteroidal.