DDSEP® 8 Quick Quiz

Question 2

Publish date: February 28, 2023

Q2. A 76-year-old man with atrial fibrillation treated with long-term anticoagulation with warfarin and coronary artery disease treated with aspirin was recently admitted with melena. Upper endoscopy revealed a duodenal ulcer with visible vessel. Endoscopic therapy was performed, and he was started on twice-daily proton-pump inhibitors (PPIs).

Which of the following is the best monitoring approach in this patient?

No monitoring of PPI side effects

Baseline neurocognitive testing to evaluate for changes in memory

Fasting glucose every 6 months to assess for presence of diabetes

Yearly dual-energy x-ray absorptiometry scans

Yearly basic metabolic profile and iron studies

Q2. Correct answer: A - No monitoring of PPI side effects.


Rationale

There are several putative risks associated with long-term PPI use: chronic kidney disease, dementia, vitamin and mineral deficiencies, and others. However, the overall quality of evidence to support these conclusions is low or very low, and the majority of the findings have low effect sizes that may be attributed to confounding. An American Gastroenterological Association clinical practice update recommended against routine monitoring for patients receiving long-term PPI treatment. However, data show that more than one-third of gastroenterologists still check for PPI side effects at least annually in their patients.


References

Freedberg DE, Kim LS, Yang YX. The Risks and Benefits of Long-Term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association. Gastroenterology. 2017;152(4):706-15. doi: 10.1053/j.gastro.2017.01.031.

Leiman DA, Ravi K, Freedberg DE, Gyawali CP. Proton Pump Inhibitor Prescribing and Monitoring Patterns Among Gastroenterology Practitioners (published online ahead of print, 2021 Oct 4). J Clin Gastroenterol. 2021;10.1097/MCG.0000000000001623. doi: 10.1097/MCG.0000000000001623.

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