Proton pump inhibitors

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Editor, – The article on proton pump inhibitors (Aust Prescr 1997;20:16) contains unfortunate special pleading which detracts from the impact which was clearly to support the restrictions on proton pump inhibitors.

The writer raises the possibility of cancer by saying 'Carcinogenesisis a long lasting adverse reaction to drugs'. This is truly a definition of the word. To then imply that the prescribing, presumably of proton pump inhibitors, could lead to 'setting in place a drug disaster' is unscientific scaremongering without something to back the assertion. Or is this meant to be a warning against all new drugs?

There is also an unfortunate phrasing in 'are these drugs honestly necessary'. The writer appears overwhelmed by high technology tests and ignores the patient even while admitting 'the poor correlation between symptoms and diagnostic tests'.

The result of the recent restrictions will be an increase in activity for the endoscopists and some more suffering for those who cannot afford these tests or who just have to wait.

R.J. Burn
General Practitioner
Chippendale, N.S.W.

Professor J. Marley, the author of the article, comments:
Treatment of reflux oesophagitis should follow the stepped care approach which starts with lifestyle measures ('Gastrointestinal drug guidelines' pages29-31). It would clearly not be advisable to deny patients who have failed treatment at earlier stepped care points, the use of proton pump inhibitors. Neither is it desirable to use these drugs for patients who have not tried more simple treatments. I stated that carcinogenesis is a long latency adverse reaction, meaning that it takes many years to become apparent, not a long lasting reaction. There is a biologically plausible mechanism which might mean an increased risk of gastric cancer through the use of these drugs, which unfortunately cannot be dismissed as unscientific scaremongering.

The article does not contain support for the current restrictions, or endoscopy, but it does contain support for safe and rational prescribing.