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2013 | 9 | 2 | 126–132
Article title

O czym warto pamiętać, stosując przewlekle inhibitory pompy protonowej?

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Title variants
EN
What is worth to remember during long-term treatment with proton pump inhibitors?
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PL
Abstracts
EN
Proton pump inhibitors (PPI) are widely used to treat patients with acid-related disorders because they are generally perceived to be safe and effective. However, as with any pharmacologic agent, they have the potential for side effects. Most of them are a direct consequence of inhibition of acid production by parietal cells (hypochlorhydria or reflex hypergastrinemia), but idiosyncratic effects, immunosuppression and other effects have also been proposed. Potential adverse events associated with PPI therapy include vitamin and mineral deficiencies, association with community-acquired infections including pneumonia and diarrhoea, hip or vertebral fractures and osteoporosis. Many studies have examined the side effects of long-term exposure. Almost all the existing data in this regard are based on observational studies that are susceptible to bias and confounding. It is important to remember that all drugs carry risk and PPI should not be denied to patients who are likely to benefit from them because of concerns about putative side effects. They should only be prescribed when there is an appropriate clinical indication and clinical guidelines can help. The lowest effective dose of PPI should be used. In event of drug-induced hypomagnesaemia or acute interstitial nephritis discontinuation of PPI is crucial. A number of simple and potentially effective preventive measures can be recommended for some of the safety concerns, even if we do not fully understand the mechanisms of most PPI-related safety issues.
PL
Inhibitory pompy protonowej (proton pump inhibitors, PPI) powszechnie uznawane są za skuteczną i bezpieczną grupę leków i znajdują szerokie zastosowanie w leczeniu chorób zależnych od wydzielania kwasu solnego w żołądku. Jednak podobnie jak inne leki mogą powodować istotne skutki uboczne. Większość z nich wynika bezpośrednio z zahamowania produkcji kwasu solnego przez komórki okładzinowe, hipochlorhydrii i wtórnej hipergastrynemii, ale możliwe są także objawy wynikające z immunosupresji i nadwrażliwości na leki. Potencjalne efekty uboczne stosowania PPI obejmują niedobór witamin i składników mineralnych, powikłania infekcyjne pod postacią pozaszpitalnego zapalenia płuc i biegunki bakteryjnej, złamania szyjki kości udowej i kości kręgosłupa oraz rozwój osteoporozy. Wiele badań oceniało do tej pory efekty uboczne powstające w trakcie przewlekłego leczenia za pomocą PPI, jednak większość z nich miało jedynie charakter obserwacyjny, a ich wyniki były niejednorodne i narażone na istotne błędy. Mimo potencjalnego ryzyka z leczenia za pomocą PPI nie należy rezygnować u osób, u których może ono przynieść korzyści kliniczne. Leki te powinny być stosowane zgodnie ze wskazaniami i wypracowanymi algorytmami postępowania. W leczeniu przewlekłym stosuje się najmniejszą skuteczną dawkę PPI. W przypadku wystąpienia hipomagnezemii lub śródmiąższowego zapalenia nerek leki te powinny być odstawione. Warto pamiętać, że szereg prostych zaleceń może istotnie poprawić bezpieczeństwo leczenia, mimo że mechanizmy, poprzez które PPI wywołują efekty uboczne, nie są do końca poznane.
Discipline
Publisher

Year
Volume
9
Issue
2
Pages
126–132
Physical description
Contributors
author
  • Klinika Gastroenterologii Onkologicznej, Centrum Onkologii – Instytut im. M. Skłodowskiej-Curie, Warszawa. Kierownik Kliniki: prof. dr hab. n. med. Jarosław Reguła, wocialt@op.pl
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Document Type
article
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bwmeta1.element.psjd-46aff45c-7596-40cb-8fd8-6b2d489a8fea
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