From the Guidelines
Long-term proton pump inhibitor (PPI) therapy is indicated for conditions such as Barrett's esophagus, clinically significant erosive esophagitis, gastroprotection in users of ASA/nonsteroidal anti-inflammatory drug at high risk for GI bleeding, and secondary prevention of gastric and duodenal peptic ulcers with no concomitant antiplatelet drugs, as outlined in the AGA clinical practice update on de-prescribing of proton pump inhibitors 1. These conditions require ongoing acid suppression to prevent complications and improve quality of life. The following conditions are definitely indicated for long-term PPI use:
- Barrett’s esophagus
- Clinically significant (LA Classification grade C/D) erosive esophagitis
- Gastroprotection in users of ASA/nonsteroidal anti-inflammatory drug at high risk for GI bleeding
- Secondary prevention of gastric and duodenal peptic ulcers with no concomitant antiplatelet drugs Additionally, PPIs are conditionally indicated for long-term use in patients with PPI-responsive endoscopy-negative reflux disease, with recurrence on PPI cessation, and esophageal strictures from GERD (ie, peptic strictures) 1. It is essential to use the lowest effective dose and periodically reassess the need for continued therapy, considering the potential risks of long-term PPI use, such as increased risk of C. difficile infections, pneumonia, bone fractures, vitamin B12 deficiency, hypomagnesemia, and chronic kidney disease 1. The decision to initiate or continue long-term PPI therapy should be made in a shared decision-making model with the patient, taking into account the potential benefits and risks, as well as the patient's preferences and values 1.
From the FDA Drug Label
Omeprazole delayed-release capsules are used in adults: • for the long-term treatment of conditions where your stomach makes too much acid. This includes a rare condition called Zollinger-Ellison Syndrome
The indication for long-term proton pump inhibitor therapy is the long-term treatment of conditions where the stomach makes too much acid, including Zollinger-Ellison Syndrome 2.
- Key points:
- Long-term treatment is used for conditions with excessive acid production
- Zollinger-Ellison Syndrome is a specific condition that may require long-term proton pump inhibitor therapy
- It is not known if omeprazole delayed-release capsules are safe and effective when used for longer than 12 months (1 year) for maintaining healing of the esophagus 2.
From the Research
Indications for Long-term Proton Pump Inhibitor Therapy
- Gastroesophageal reflux disease (GERD) with acid-related complications, such as erosive esophagitis or peptic stricture, as indicated by 3
- Barrett's esophagus with symptomatic GERD, as recommended by 3
- Asymptomatic patients with Barrett's esophagus, as suggested by 3
- Patients at high risk for ulcer-related bleeding from non-steroidal anti-inflammatory drugs (NSAIDs), as advised by 3
- Helicobacter pylori infection and associated duodenal ulcer disease, as mentioned in 4
- Zollinger-Ellison syndrome and other hypersecretory syndromes, as noted in 4
- Prevention of gastroduodenal mucosal lesions and symptoms in patients taking NSAIDs or antiplatelet therapies with gastrointestinal risk factors, as indicated by 5
Considerations for Long-term Proton Pump Inhibitor Therapy
- Patients with uncomplicated GERD who respond to short-term PPIs should attempt to stop or reduce them, as recommended by 3
- The dose of long-term PPIs should be periodically reevaluated to prescribe the lowest effective dose, as advised by 3
- Long-term PPI users should not routinely use probiotics to prevent infection, raise their intake of calcium, vitamin B12, or magnesium beyond the Recommended Dietary Allowance (RDA), or screen or monitor bone mineral density, serum creatinine, magnesium, or vitamin B12, as suggested by 3 and 6