From the Guidelines
Long-term proton pump inhibitor (PPI) therapy is indicated for patients with eosinophilic oesophagitis (EoE) who achieve histological response and are in clinical and histological remission. This recommendation is based on the British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines, which suggest that maintenance PPI therapy can be considered as a long-term treatment in patients with EoE who are in clinical and histological remission 1. The guidelines are supported by studies that show a high risk of relapse on stopping therapy, with 87.5% of patients experiencing symptom recurrence and all exhibiting histological recurrence after discontinuing treatment 1. Key points to consider include:
- Histological response to initial PPI treatment is a predictor of long-term remission, with 70.1% of patients achieving long-term histological remission in one prospective study 1
- Maintenance PPI therapy has been shown to be effective in sustaining clinicopathological remission, with 69.9% of patients exhibiting sustained remission in a registry study 1
- The effectiveness of PPIs in maintaining disease remission is closely related to the degree of response seen with initial treatment 1
- Common PPIs used for long-term therapy include omeprazole, esomeprazole, pantoprazole, and lansoprazole, with dosages varying depending on the patient's response and clinical judgment.
From the FDA Drug Label
5.6 Cyanocobalamin (Vitamin B12) Deficiency Daily treatment with any acid-suppressing medications over a long period of time (e.g., longer than three years) may lead to malabsorption of cyanocobalamin (Vitamin B12) caused by hypo- or achlorhydria. 5.7 Hypomagnesemia Hypomagnesemia, symptomatic and asymptomatic, has been reported rarely in patients treated with PPIs for at least three months, in most cases after a year of therapy. 5.11 Fundic Gland Polyps PPI use is associated with an increased risk of fundic gland polyps that increases with long-term use, especially beyond one year.
The indication for long-term proton pump inhibitor therapy is the prevention of fundic gland polyps, cyanocobalamin (Vitamin B12) deficiency, and hypomagnesemia, which are associated with long-term use of PPIs, especially beyond one year 2.
- Key points:
- Long-term use: beyond one year
- Increased risk: of fundic gland polyps, cyanocobalamin deficiency, and hypomagnesemia
- PPI therapy: should be used for the shortest duration possible to minimize risks.
From the Research
Indications for Long-Term Proton Pump Therapy
- Zollinger-Ellison syndrome is an indication for long-term proton pump inhibitor therapy, as evidenced by studies 3, 4, 5, 6.
Characteristics of Zollinger-Ellison Syndrome
- Patients with Zollinger-Ellison syndrome often require high doses of proton pump inhibitors to control gastric acid secretion 3, 4, 5, 6.
- Long-term treatment with proton pump inhibitors, such as omeprazole, can effectively control basal acid output in patients with Zollinger-Ellison syndrome 3, 5, 6.
Comparison with Short-Term Therapy
- Short-term proton pump inhibitor therapy is often used to heal and relieve symptoms of gastric or duodenal ulcers and gastro-oesophageal reflux, whereas long-term therapy is typically reserved for conditions like Zollinger-Ellison syndrome 7.
- Patients with Zollinger-Ellison syndrome may require ongoing treatment with proton pump inhibitors to prevent recurrence of symptoms and maintain control of gastric acid secretion 3, 4, 5, 6.