Для снижения риска нежелательных явлений можно предложить ряд простых мер, которые могут оказаться эффективными, несмотря на неполную ясность лежащих в основе механизмов. Например, связь ИПП с повышенным риском переломов может объясняться нарушением всасывания кальция; этот риск легко снизить за счет увеличения потребления кальция (лучше в растворимой форме, в составе пищи, например молочных продуктов). Это хороший подход, т. к. в США у большей части взрослого населения потребление кальция меньше суточной потребности. Другой пример -- отказ от назначения ИПП пациентам без абсолютных к этому показаний, получающим антибиотики или совершающим поездки в страны с высоким риском кишечных инфекций, либо ограничение приема НПВС у пожилых больных артритом. Уровень витамина В12 следует проверять у всех пожилых пациентов из группы риска, независимо от того, получают они ИПП или нет. Если требуется отмена ИПП, независимо от ее причины желательно это делать постепенно.
Литература
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