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Säuresuppression im Alter

Acid inhibition in the elderly

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Der Gastroenterologe Aims and scope

Zusammenfassung

Säurehemmende Pharmaka (in erster Linie Protonenpumpeninhibitoren, PPI) gehören zu den Medikamenten, die bei älteren Patienten am häufigsten verordnet werden, allerdings nicht immer indikationsgerecht. Sie dienen in erster Linie der Prävention und Therapie von peptischen Ulzera unter der Gabe von ulzerogenen Substanzen und der Therapie der Refluxkrankheit. Trotz ihres hohen Sicherheitsprofils werden derzeit mehrere Risiken in der PPI-Langzeittherapie diskutiert (Frakturgefahr, Begünstigung einer pseudomembranösen Kolitis, Entwicklung eines Vitamin-B12-Mangels), aber keines dieser potenziellen Risiken ist bisher auch nur annähernd gut belegt. Dennoch gilt: PPI nur bei korrekter Indikation einsetzen, Notwendigkeit in der Dauertherapie kritisch überprüfen (aber nicht leichtfertig absetzen, wenn indiziert), Dosierung so niedrig wie erforderlich wählen.

Abstract

Acid inhibitory drugs (mostly proton pump inhibitors, PPI) are among the most prescribed pharmaceuticals for elderly people but not always according to current guidelines. Predominant indications are prevention and treatment of peptic ulcers including those induced by ulcerogenic drugs and therapy of gastroesophageal reflux disease. Despite the excellent safety profile some risks are currently under intense discussion (e.g. increased risk of bone fractures, Clostridium difficile-associated colitis and development of cobalamine deficiency) but none of these potential hazards are well proven. Nevertheless, the following recommendations are important: PPI should only be administered if certainly indicated, there should be regular evaluation whether continuous therapy is still needed (but PPI should not be discontinued with levity) and dosing should be as low as necessary.

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  1. Klinik für Allgemeine Innere Medizin und Gastroenterologie, HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland

    H. Koop

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Correspondence to H. Koop.

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Koop, H. Säuresuppression im Alter. Gastroenterologe 7, 308–313 (2012). https://doi.org/10.1007/s11377-012-0662-1

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  • DOI: https://doi.org/10.1007/s11377-012-0662-1

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