2023 In dealing with a patient who wanted to start long term PPI use

In dealing with a patient who wanted to start long term PPI use I would examine a few things. I would consider why they would need the PPI, their age as well as modifiable lifestyle changes. I would talk with them about the benefits as well as the risks of taking and using a PPI for long term. Depending on their age I would suggest getting a bone scan prior to starting a PPI with the risk of osteoporosis and bone fractures being increased with the use of PPIs. I would involve them in the decision making and provide education regarding lifestyle modifications such as dietary changes, weight loss, elevating the bed and smoking cessation if they are a smoker.  

According to Nehra et al. (2018) the increased risk of Alzheimer and dementia is 38-44% in patient 75 years older, therefore I would be cautious prescribing a long-term PPI for this age group. This age group is also at risk for increased bone loss and fractures therefore PPIs should not be used longer than 8 weeks (Maes et al., 2017).

H. pylori is a gastric infection that causes gastritis and can cause ulcers. The treatment for H. pylori would be antibiotics in addition to a PPI to suppress gastric acids (Scott et al., 2016). 

References

Maes, M. L., Fixen, D. R., & Linnebur, S. A. (2017). Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence. Therapeutic advances in drug safety, 8(9), 273–297. https://doi.org/10.1177/2042098617715381

Nehra, A. K., Alexander, J. A., Loftus, C. G., & Nehra, V. (2018). Proton pump inhibitors: Review of emerging concerns. Mayo Clinic Proceedings, 93(2), 240–246. https://doi.org/10.1016/j.mayocp.2017.10.022