The PPIs and Unhealthy Consumer Driven Prescribing
Posted Nov 04 2009 10:05pm
Dr Rainer Kumm says: “Drugs are not bad or good in themselves – they are just tools. For example, the proton pump inhibitors (PPI’s) such as Omeprazole are very useful for acute gastrointestinal bleeds but harmful if used longer than 3 months”. Dr Kumm goes onto describe how he feels that the label “Proton Pump Inhibitor”, “is a bit of a fake as it would be more accurate to call them ‘parietal cell blockers’, but this doesn’t sound so good ”. The point he makes is that it is not as simple as simply switching off the acid supply. PPIs will also have the direct affect of suppressing intrinsic factor. Intrinsic Factor is essential for Vitamin B12 re-absorption. Since normal B12 storage in the body lasts for about 3 months, levels can become rapidly depleted.
However, despite this knowledge whole populations are now being fed PPI’s without much debate. Neuropathies, mood disorders, dementia are all known to be linked to vitamin B12 deficiency. Macrocytaemia is a late stage symptom of B12 deficiency. “We know all this and yet these facts do not seem to have an impact on prescribing practice. Long term acid suppression to my knowledge also impairs calcium re-absorption, so long term PPI use is also a contributing factor for osteoporosis.
In Dr Kumm’s opinion, PPI’s have become a “lifestyle” drug, which are now present in almost any household – similar to the SSRI’s. He says; “For some reason nature has put acid in our stomachs, apart from anything else it’s a useful disinfectant. In my view PPI’s for situations such as exam stress or indigestion where a reduction of coffee and cigarettes plus some classic bicarbonate tablets or Gaviscon maybe might give symptomatic and harmless relief is an example of inappropriate consumer driven prescribing. A sympathetic talk and targeted stress relief / counselling might be what the patient really needs. This form of prescribing is something that I call a ‘dangerous placebo’ i.e. a drug without therapeutic benefit, but with pharmacologic activity and with associated side effects.
So what is certainly useful in the short term becomes a boomerang in un-reflected long term and unnecessary prescribing. Patients also often report a ‘rebound’ effect when they stop using a PPI. The stomach reacts by producing even higher levels of acid with associated pain – and so this naturally prolongs the desire to keep taking the drug.
Dr Rainer Kumm says: “Drugs are not bad or good in themselves – they are just tools. For example, the proton pump inhibitors (PPI’s) such as Omeprazole are very useful for acute gastrointestinal bleeds but harmful if used longer than 3 months”. Dr Kumm goes onto describe how he feels that the label “Proton Pump Inhibitor”, “is a bit of a fake as it would be more accurate to call them ‘parietal cell blockers’, but this doesn’t sound so good ”. The point he makes is that it is not as simple as simply switching off the acid supply. PPIs will also have the direct affect of suppressing intrinsic factor. Intrinsic Factor is essential for Vitamin B12 re-absorption. Since normal B12 storage in the body lasts for about 3 months, levels can become rapidly depleted.
However, despite this knowledge whole populations are now being fed PPI’s without much debate. Neuropathies, mood disorders, dementia are all known to be linked to vitamin B12 deficiency. Macrocytaemia is a late stage symptom of B12 deficiency. “We know all this and yet these facts do not seem to have an impact on prescribing practice. Long term acid suppression to my knowledge also impairs calcium re-absorption, so long term PPI use is also a contributing factor for osteoporosis.
In Dr Kumm’s opinion, PPI’s have become a “lifestyle” drug, which are now present in almost any household – similar to the SSRI’s. He says; “For some reason nature has put acid in our stomachs, apart from anything else it’s a useful disinfectant. In my view PPI’s for situations such as exam stress or indigestion where a reduction of coffee and cigarettes plus some classic bicarbonate tablets or Gaviscon maybe might give symptomatic and harmless relief is an example of inappropriate consumer driven prescribing. A sympathetic talk and targeted stress relief / counselling might be what the patient really needs. This form of prescribing is something that I call a ‘dangerous placebo’ i.e. a drug without therapeutic benefit, but with pharmacologic activity and with associated side effects.
So what is certainly useful in the short term becomes a boomerang in un-reflected long term and unnecessary prescribing. Patients also often report a ‘rebound’ effect when they stop using a PPI. The stomach reacts by producing even higher levels of acid with associated pain – and so this naturally prolongs the desire to keep taking the drug.
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Tags: gastrointestinal bleeds, proton pump inhibitor