Protons pump inhibitor treatment and lower gastrointestinal bleeding: Balancing risks and benefits

doi:10.3748/wjg.v22.i48.10477

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Dec 28, 2016 (publication date) through Mar 2, 2026

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Dec 28, 2016; 22(48): 10477-10481
Published online Dec 28, 2016. doi: 10.3748/wjg.v22.i48.10477

Protons pump inhibitor treatment and lower gastrointestinal bleeding: Balancing risks and benefits

Alberto Lué, Angel Lanas

Alberto Lué, Angel Lanas, Digestive Diseases Service, University Clinic Hospital Lozano Blesa, Avenida San Juan Bosco, 50009 Zaragoza, Spain

Alberto Lué, Angel Lanas, IIS Aragon, Avenida San Juan Bosco, 50009 Zaragoza, Spain

Angel Lanas, University of Zaragoza, Calle de Pedro Cerbuna, 50009 Zaragoza, Spain

Angel Lanas, CIBERehd, Av. Monforte de Lemos, 28029 Madrid, Spain

Author contributions: Lué A and Lanas A contributed to this paper.

Conflict-of-interest statement: Lué A and Lanas A declare no conflict of interest related to this publication.

Correspondence to: Angel Lanas, MD, DSc, Professor, Chairman, Digestive Diseases Service, University Clinic Hospital Lozano Blesa, Avenida San Juan Bosco, 50009 Zaragoza, Spain. alanas@unizar.es

Telephone: +34-97-6768886 Fax: +34-97-6768846

Received: August 27, 2016
Peer-review started: August 31, 2016
First decision: September 20, 2016
Revised: September 28, 2016
Accepted: November 12, 2016
Article in press: November 13, 2016
Published online: December 28, 2016
Processing time: 121 Days and 0.1 Hours

Core Tip

Core tip: Proton pump inhibitors (PPIs) reduce the risk of upper, but not lower gastrointestinal bleeding (LGB) in patients receiving nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin. PPIs could exacerbate small bowel damage related to NSAIDs and low-dose aspirin, which contributes to an increased risk of LGB possibly related to pathological modifications of small bowel microbiota. LGB is a life-threatening condition, especially in older patients with comorbidities treated with NSAIDs, aspirin, or anticoagulants. No accepted treatments exist for decreasing the risk of LGB in these patients. Future research is needed on reducing inappropriate PPI use and evaluating possible pharmacologic interventions to decrease the risk of gastrointestinal bleeding.