Relevance of early management by proton-pump inhibitor in acute upper gastro-intestinal tract disorder: A scoping review - 12/10/23
, Mikhail Dziadzko b, c, Charles Grégoire d, e, Michel Galinski f, g, Claude Dussart a, Virginie-Eve Lvovschi b, hAbstract |
Background |
Proton-pump inhibitors (PPI) are frequently used in the emergency and general practice settings in several clinical presentations linked to acute upper gastro-intestinal tract disorders as abdominal or chest pain without recommendations.
Objective |
The aim of this scoping review was to assess pain reduction, diagnostic performance, and safety in the first 24 h-management in primary care or emergency medicine.
Methods |
Search was realized by 2 independent reviewers in PubMed, Embase, and Web of Science following PRISMA-ScR guidelines. Only original articles or systematic reviews in English were included. Studies about chronic and/or bleeding conditions, therapeutic cocktails and studies without pain evaluation were excluded. Two methodologies were used for bias estimation.
Results |
From 4442 titles, 79 full-text articles were assessed, and 9 were included. There is no strong evidence supporting the use of PPI as a first line analgesic or diagnostic test in acute syndromes linked to acute upper gastro-intestinal tract disorder. A small effect in pain reduction was retrieved in patients with low pain scores. A poor additional value in patients with gastric reflux, and a low specificity compared to other diagnostic tests were observed. A short-term PPI administration appears to be safe with low risk of serious allergic reactions, and poor adverse effects (moderate evidence).
Conclusion |
Although PPIs may contribute to the multimodal analgesia in acute settings, with few and/or minor side effects, no recommendation can be drawn for their use as a primary analgesic. Data regarding the relevance of the PPI test are much less clear, no data regarding care pathways are available.
Le texte complet de cet article est disponible en PDF.Graphical Abstract |
Highlights |
• | Scoping review on first 24 h management of upper gastrointestinal tract disorders in Primary Care and Emergency Medicine. |
• | No robust study allows recommendations about PPIs use as a first-line pain killer in the emergency department. |
• | PPI testing in primary care or emergency department is not established, particularly in non-cardiac chest pain. |
• | PPIs have very low risk of severe allergic events. |
• | To prevent IPP misuse, more studies need to be carried out on the care pathways after the first 24 h management. |
Keywords : Proton pump inhibitor, Pain management, Primary care, Misuse, Abdominal pain, non-cardiac chest pain
Plan
Vol 167
Article 115523- novembre 2023 Retour au numéro
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