BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

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Syphilis and gonorrhoea diagnoses see significant increase

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  • BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

    BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

    Wednesday, 25 July 2018 13:55
  • DOACs associated with reduced risk of major bleeding compared to warfarin

    DOACs associated with reduced risk of major bleeding compared to warfarin

    Wednesday, 11 July 2018 13:11
  • Recorded penicillin allergy associated with increased risk of MRSA and C difficile

    Recorded penicillin allergy associated with increased risk of MRSA and C difficile

    Tuesday, 03 July 2018 16:42
  • Syphilis and gonorrhoea diagnoses see significant increase

    Syphilis and gonorrhoea diagnoses see significant increase

    Monday, 11 June 2018 14:16
  • Anticholinergics linked to increased risk of dementia

    Anticholinergics linked to increased risk of dementia

    Monday, 30 April 2018 12:08

Umesh Modi is a chartered accountant, and Pamini Jatheeskumar is a chartered certified accountant at Silver Levene...
  Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead...
Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
More inWhite Papers  

a alcohol imageOctober 17 2017

Protein pump inhibitors could supress stomach acid secretion to the extent it lets intestinal bacteria trigger or worsen liver disease, a new study has proposed.

 The US study has looked at the affect of the PPI omeprazole on the progression of liver disease in rats with alcohol-induced liver disease. Acid suppression was found to be linked to an increase in Enterococcus in the intestine which then migrated to the liver, causing hepatic inflammation, and stimulating any existing liver disease.

In addition, the researchers looked at the association between PPI usage and the development of alcoholic liver disease (ALD) among chronic alcohol abusers. Data from 4,830 people was analysed, indicating that the 10-year risk of an ALD diagnosis was 20.7% in people who were active PPI users. This compares to 16.1% in chronic alcohol users who previously used PPIs, and 12.4% for people who had never used a PPI.

“In alcohol-dependent patients, gastric acid suppression promotes the onset and progression of liver disease,” said the researchers. Although further data analysis was required on the cohort, the researchers proposed that “clinicians should consider withholding medications that suppress gastric acid, unless there is a strong medical indication” in people with alcohol-dependency.

John Smith, Chief Executive of the Proprietary Association of Great Britain, has issued a response to the study. “The researchers concluded that because of limitations in their study’s methodology, they couldn’t rule out the possibility that there could be other unidentified factors that could contribute to the link between PPIs use and liver disease. This study use data collected from mice and by reviewing a patient database,” he said.

“PPIs available over-the-counter (OTC) are intended for short-term use only and are an appropriately safe way to manage symptoms, if used in accordance with the clear on-pack instructions and the patient information leaflet inside.

Mr Smith advised people using PPIS to consult a pharmacist if symptoms do not improve after 14 days or if they have any concerns about their medicine.

Links:
C Llorente et al. ‘Gastric Acid Suppression Promotes Alcoholic Liver Disease by Inducing Overgrowth of Intestinal Enterococcus’. Published via Box app                  
PAGB response  

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