Long term effects of PPI

Long term PPI use is associated with the following effects. The level of evidence for such association is sparse. Clinician must be aware of the following risks and take appropriate measure if required. 

• Vitamin B12 deficiency
• Increased risk of fractures (osteoporosis)
• Hypergastrinemia
• Increased risk of infections: nosocomial pneumonia, community acquired Clostridium difficile, SBP in ascites

Gastrointestinal System classification

Drugs for acid peptic disorders 
Anti-emetic drugs 
Emetics 
Laxatives 
Dehydration in diarrhoea 
Antidiarrheal agents 
Agents for irritable bowel syndrome 
Probiotics and prebiotics
Gallstone dissolving agents

Gallstone dissolving agents

Chenodeoxycholic acid (Chenodiol)

Ursodeoxycholic acid (Ursodiol)

Obeticholic Acid

Probiotics and prebiotics classification

A) PROBIOTICS

Beneficial microbes

Saccharomyces boulardii

Lactobacillus acidophilus

Lactobacillus bifidus

Bifidobacterium lactis

Streptococcus salivarius

Streptococcus thermophilus

Streptococcus faecalis

Yogurt (curds) 

B) PREBIOTICS

Promotes growth of beneficial microbes

Lactulose

Inulin

Fructose based oligosaccharides (FOS)

Agents for irritable bowel syndrome classification

Alosetron

Linactolide

Eluxadoline

Lubiprostone

Rifaximin

Antidiarrheal agents classification

1) Antimicrobial Therapy (only for certain conditions)

Tinidazole

Metronidazole

Cotrimoxazole

Ciprofloxacin

Tetracycline

2) Drugs for IBD

a) 5-ASA compounds

Sulfasalazine

Mesalazine

Olsalazine

Balsalazine

b) Glucocorticoids

Prednisolone

Hydrocortisone

c) Immunosuppressants

Azathioprine

Methotrexate

Cyclosporine

Infliximab

3) Nonspecific Antidiarrhoeal Drugs

i) Absorbents

Ispaghula

Psyllium

Sterculia

Methyl cellulose

ii) Gastrointestinal protectives and adsorbents

Pectin

Bismuth salts

Activated wood charcoal

iii) Antisecretory

Racecadotril

Bismuth subsalicylate

Octreotide

Anticholinergics

iv) Antimotility drugs

Diphenoxylate

Loperamide

Codeine

v) Others

Lactobacillus preparations

Berberine 

Dehydration in diarrhoea management

a) Intravenous Rehydration Ringer lactate (RL)

ii) Dhaka fluid [Nacl -5 g, KCI -1 g, NaHcoa -4 g in -1 L of water or 5% glucose solution]

iii) Normal saline & Dextrose normal saline (used in case of non availability of RL)

b) Oral Rehydration (constituents for 1L of water)

a)WHO/ UNICEF recommended standard ORs (for Cholera)

Total osmolality 311 mmol/L

NaCl 3.5 g

KCI 1.5 g

Trisodium Citrate 2.9 g

Glucose 20 g

b) New formula WHO-ORS/ Reduced osmolality ORS (for other diarrhoeas)

Total osmolality 245 mmol/L

NaCl 2.6 g

KCI 1.5 g

Trisodium citrate 2.9 g

Glucose 13.5 g

c) Super ORS

Rice/wheat/potato based ORS

d) ResoMal

Rehydration solution for malnourished children

Total osmolality 300 mmol/L

NaCl 1.75 g

KCI 2.54 g

Sucrose 25 g

Glucose 10 g