Protons pump inhibitor treatment and lower gastrointestinal bleeding: Balancing risks and benefits

• Published in: World journal of gastroenterology : WJG 2016-12, Vol.22 (48), p.10477-10481
• Main Authors: Lué, Alberto, Lanas, Angel
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Aspirin - administration & dosage; Aspirin - adverse effects; Aspirin - therapeutic use; Gastrointestinal Hemorrhage - chemically induced; Gastrointestinal Hemorrhage - prevention & control; Gastrointestinal Microbiome - drug effects; Humans; Inappropriate Prescribing - prevention & control; Lower Gastrointestinal Tract - drug effects; Probiotics - therapeutic use; Proton Pump Inhibitors - adverse effects; Proton Pump Inhibitors - therapeutic use; Risk Assessment; Risk Factors; Upper Gastrointestinal Tract - drug effects
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v22.i48.10477

Proton pump inhibitors(PPIs) represent a milestone in the treatment of acid-related diseases, and are the mainstay in preventing upper gastrointestinal bleeding in high-risk patients treated with nonsteroidal antiinflammatory drugs(NSAIDs) or low-dose aspirin. However, this beneficial effect does not extend to the lower gastrointestinal tract. PPIs do not prevent NSAID or aspirin-associated lower gastrointestinal bleeding(LGB). PPIs may increase both small bowel injury related to NSAIDs and low-dose aspirin treatment and the risk of LGB. Recent studies suggested that altering intestinal microbiota by PPIs may be involved in the pathogenesis of NSAID-enteropathy. An increase in LGB hospitalization rates may occur more frequently in older patients with more comorbidities and are associated with high hospital resource utilization, longer hospitalization, and increased mortality. Preventive strategies for NSAID and aspirin-associated gastrointestinal bleeding should be directed toward preventing both upper and lower gastrointestinal damage. Future research should be directed toward identifying patients at low-risk for gastrointestinal events associated with the use of NSAIDs or aspirin to avoid inappropriate PPI prescribing. Alternatively, the efficacy of new pharmacologic strategies should be evaluated in high-risk groups, with the aim of reducing the risk of both upper and lower gastrointestinal bleeding in these patients.