Proton pump inhibitors or PPIs and the magnetizer
Proton pump inhibitors or PPIs (omeprazole, lansoprazole, esomeprazole, rabeprazole or pantoprazole) are consumed by 16 million French people each year to temper acid secretions from the stomach.
“They are not addictive, are not too expensive, have few side effects and have a high actual benefit of 65%. "
Professor Pierre Cochât (Chairman of the Transparency Commission of the High Authority for Health: "these are excellent drugs, as there are few."
They have precise prescription indications: in the event of peptic ulcer disease in which the superficial lesion is located at the level of the stomach wall or the first part of the intestine, of gastroesophageal reflux disease (GERD), when the Gastric acid secretions cause discomfort and burns as they move up the esophagus and finally to prevent damage that could occur with the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Why do PPIs nevertheless find themselves in the crosshairs of health authorities?
According to 2 surveys from the drug agency in 2015 and from the health insurance in 2019: they would be the subject of prescriptions that are too long or unjustified in 40 to 80% of cases. HAS has decided to promote better use of it.
Taking PPIs is not justified in an increasing number of cases. Almost 80% of patients without risk factors are prescribed a PPI when prescribing NSAIDs (nonsteroidal anti-inflammatory drugs) to prevent the risk of peptic ulcer disease.
The prescription period for the treatment of GERD (gastroesophageal reflux disease) is often too long. She should be reassessed within 8 weeks. The benefit of the drug should be re-evaluated after 4 weeks with possibly endoscopy to confirm the diagnosis of GERD.
Another common mistake is that these drugs are given too much to young children (they do not need PPIs in uncomplicated regurgitation) and the elderly (they are at risk of drug interactions and side effects as they often take several other drugs and are often fragile).
Studies with conflicting results have shown a risk of cardiovascular problems, vitamin deficiencies, kidney failure and osteoporosis.
The proven risk, but low, is that of intestinal infections.
The Haute Autorité de santé has decided to raise awareness about the huge volume of unnecessary prescriptions with the help of a campaign:
- from pharmacists who process prescriptions and advise people who buy over-the-counter PPIs;
- from physicians whose greatest prescribers are cardiologists who are afraid of gastric irritations linked to anticoagulant treatment. Emergency physicians, rheumatologists to support NSAIDs and general practitioners are also concerned;
- with patients so that they can discuss the subject "why am I taking this medicine?" With their doctors.
It is important to better prescribe them in first intention. Although these drugs are well tolerated, their renewal should raise more questions.
It should be explained to the patient that while this treatment has a beginning, it also has an end.
Should the patient be accompanied when stopping PPIs?
Yes, stopping PPIs, after taking them continuously, triggers a rebound in acidity that can appear for one to two months. The time it takes for gastric secretions to rebalance.
It is essential to warn the patient and to give him information to protect himself from it. It would be a shame to ignore the magnetizer. In the diet, no irritating or oily things. Do not lie down after eating, exercise to speed up gastric emptying, avoid smoking, and in the context of being overweight, it is useful to alleviate abdominal pressure when losing weight.