PROTON NASOS INGIBITORLARI (PPI)NI UZOQ MUDDAT QABUL QILISH: FOYDA–XAVF BALANSI, NOO‘RIN BUYURILISH VA DEPRESKRIBING STRATEGIYALARI
Ключевые слова:
proton nasos ingibitorlari, GERK, eroziv ezofagit, peptik yara, polifarmatsiyaАннотация
Proton nasos ingibitorlari (PPI) gastroezofageal reflyuks kasalligi (GERK), eroziv ezofagit, peptik yara va ayrim yuqori GI qon ketish xavfi yuqori bemorlarda profilaktika uchun eng samarali antisekretor vositalardan hisoblanadi. Shu bilan birga, so‘nggi yillarda PPI’larni uzoq muddat “avtomatik” davom ettirish, aniq ko‘rsatmasiz buyurish va polifarmatsiyani kuchaytirish holatlari ko‘paygani qayd etilmoqda. Bu tahliliy maqolada 2016–2025 yillardagi klinik qo‘llanmalar, amaliy tavsiyalar, randomizatsiyalangan tadqiqotlar hamda sistematik sharh va meta-tahlillar asosida PPI’larning uzoq muddatli qo‘llanishida “foyda–xavf” balansi ko‘rib chiqildi. Asosiy e’tibor noo‘rin buyurilish sabablari, uzoq muddatli davolashda uchrashi mumkin bo‘lgan nojo‘ya holatlar (rebound kislota gipersekresiyasi, enterik infeksiyalar, gipomagnezemiya, suyak salomatligi va buyrak bilan bog‘liq xavflar), shuningdek depreskribing (bosqichma-bosqich kamaytirish yoki to‘xtatish)ning amaliy strategiyalariga qaratildi. AGA best-practice bayonotlariga ko‘ra, PPI’ni to‘xtatish qarori nojo‘ya hodisalardan “qo‘rqish” asosida emas, balki klinik ko‘rsatmaning mavjud-yo‘qligi va yuqori GI qon ketish xavfi baholangan holda qabul qilinishi kerak.¹ Depreskribing muvaffaqiyatining kaliti — indikatsiyani hujjatlashtirish, yuqori xavf guruhlarini ajratish, bemorni rebound simptomlar haqida oldindan ogohlantirish hamda “eng past samarali doza” yoki “on-demand” rejimiga o‘tishdir.
Библиографические ссылки
¹ Targownik L.E., Fisher D.A., Saini S.D. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review // Gastroenterology. – 2022. – Vol. 162, №4. – P. 1334–1342. – DOI: 10.1053/j.gastro.2021.12.247.
² Katz P.O., Dunbar K.B., Schnoll-Sussman F.H., Greer K.B., Yadlapati R., Spechler S.J. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease // Am J Gastroenterol. – 2022. – Vol. 117, №1. – P. 27–56. – DOI: 10.14309/ajg.0000000000001538.
³ Freedberg D.E., Kim L.S., Yang Y.-X. 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. – Vol. 152, №4. – P. 706–715. – DOI: 10.1053/j.gastro.2017.01.031.
⁴ Shanika L.G.T., Reynolds A., Pattison S., Braund R. Proton pump inhibitor use: systematic review of global trends and practices // Eur J Clin Pharmacol. – 2023. – Vol. 79, №9. – P. 1159–1172. – DOI: 10.1007/s00228-023-03534-z.
⁵ Othman F., Crooks C.J., Card T.R. Community acquired pneumonia incidence before and after proton pump inhibitor prescription: population based study // BMJ. – 2016. – Vol. 355. – i5813. – DOI: 10.1136/bmj.i5813.
⁶ Namikawa K., Björnsson E.S. Rebound Acid Hypersecretion after Withdrawal of Long-Term Proton Pump Inhibitor (PPI) Treatment—Are PPIs Addictive? // Int J Mol Sci. – 2024. – Vol. 25, №10. – Art. 5459. – DOI: 10.3390/ijms25105459.
⁷ Srinutta T., Chewcharat A., Takkavatakarn K., Praditpornsilpa K., Eiam-Ong S., Jaber B.L., Susantitaphong P. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies // Medicine (Baltimore). – 2019. – Vol. 98, №44. – e17788. – DOI: 10.1097/MD.0000000000017788.
⁸ D’Silva K.M., Mehta R., Mitchell M., va boshq. Proton pump inhibitor use and risk for recurrent Clostridioides difficile infection: a systematic review and meta-analysis // Clin Microbiol Infect. – 2021. – Vol. 27, №5. – P. 697–703. – DOI: 10.1016/j.cmi.2021.01.008.
⁹ Lespessailles E., Toumi H. Proton Pump Inhibitors and Bone Health: An Update Narrative Review // Int J Mol Sci. – 2022. – Vol. 23, №18. – Art. 10733. – DOI: 10.3390/ijms231810733.
¹⁰ Wu C.-C., Liao M.-H., Kung W.-M., Wang Y.-C. Proton Pump Inhibitors and Risk of Chronic Kidney Disease: Evidence from Observational Studies // J Clin Med. – 2023. – Vol. 12, №6. – Art. 2262. – DOI: 10.3390/jcm12062262.
¹¹ Moayyedi P., Eikelboom J.W., Bosch J., va boshq. Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin // Gastroenterology. – 2019. – Vol. 157, №3. – P. 682–691.e2. – DOI: 10.1053/j.gastro.2019.05.056.
¹² Lazarus B., Chen Y., Wilson F.P., va boshq. Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease // JAMA Intern Med. – 2016. – Vol. 176, №2. – P. 238–246. – DOI: 10.1001/jamainternmed.2015.7193.
¹³ Nochaiwong S., va boshq. Association between proton pump inhibitor use and the risk of adverse kidney outcomes: a systematic review and meta-analysis // Nephrol Dial Transplant. – 2018. – Vol. 33, №2. – P. 331–342. – DOI: 10.1093/ndt/gfx343.
¹⁴ By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults // J Am Geriatr Soc. – 2023. – Vol. 71, №7. – P. 2052–2081. – DOI: 10.1111/jgs.18372.
