GERD- Management and side effects-
Effective long term therapy for GERD:
major drugs used are PPI’s and H2RA group of drugs.
The Long-term treatment options in reflux disease include continuous maintenance therapy, mainly for those with erosive reflux disease. Continuous maintenance therapy is a daily administration for months or even years to prevent relapse of GER symptoms.
For patients with more severe symptoms require long term maintenance treatment for relief of symptoms. These studies have shown that one can achieve symptom control as well as maintain healing of mucosa. Adverse events GERD- management and side effects are rare.
Disadvantages of Long-term Proton Pump Inhibitors Use
I) Adverse Events Unrelated to Acid Inhibition
Possible Allergic Reaction to Drug:
Anaphylaxis, pancytopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, acute liver damage, Lyell syndrome, Stevens-Johnson syndrome, interstitial nephritis, and rhabdomyolysis may occur in a small number of cases treated with a PPI, as well many other types of drugs.
Diarrhea is frequently experienced by patients being treated with PPIs. Some cases of PPI-related diarrhea may be complicated with collagenous colitis.
Acute Interstitial Nephritis and Chronic Kidney Disease:
It has been reported that interstitial nephritis may occur in patients treated with a PPI, possibly because of an allergic reaction to the drug, though the precise mechanism is not clear.
Drug Interaction During Activation or Degradation Phase in Liver:
PPIs administration in patients treated with clopidogrel may decrease its anti-thrombotic activity and increase the risk of cardiovascular events though there is no conclusive evidence of the same.
The increased risk of dementia in elderly persons treated with PPIs based on retrospective studies on a German database. Many studies on this are inconclusive.
II) Acid Inhibition Related Adverse Events
PPIs may also decrease anti-bacterial immunity. But, a meta-analysis of prospective randomized controlled studies did not show an increased risk of pneumonia during the administration of various PPIs.
- Increased Gastrointestinal Infection:
Bacteria causing gastrointestinal infection may have an increased chance to infect and grow in the gastrointestinal tract when gastric acid secretion is suppressed by a PPI. Several studies have examined the risk of C. difficile enteritis in cases treated with long term PPIs but still, results are inconclusive.
Less common and In-conclusive adverse effects (Miscellaneous)
- Gastric Neuroendocrine Tumor
- Gastric Fundic Mucosal Hypertrophy
- Changes in Gut Microbiome and increase Small Intestinal Bacterial Overgrowth
- Decreased Absorption of Nutrients
- Gastric Fundic Gland Polyp
- Gastric and Colon Cancer
- Spontaneous Bacterial Peritonitis and Hepatic Encephalopathy
- Drug Interactions