Fact or fib? PPIs, fifth disease and angular cheilitis
Vol.20, No.05, August 2012

Some of the clinical statements below are true, and some are not. Can you distinguish the facts from the fibs on proton pump inhibitors, fifth disease and angular cheilitis?

1. Proton pump inhibitors

True / False

a) Reduce gastric acid secretion by up to 75%.

b) Can heal most cases of esophagitis within 3 months.

c) Increase the risk of bacterial gastroenteritis when travelling abroad.

d) Increase fracture risk with long-term use.

e) Irreversibly bind to the gastric “proton pump” enzyme (H+/K+ ATPase), deactivating it.

f) Because of the irreversibility of proton pump inhibiton, PPIs inhibit acid production even after being eliminated from the system.

g) Long-term use will permanently inhibit acid production even after drug is discontinued.

h) Increase the risk of C. difficile infection.

i) Can interfere with absorption of vitamin B12.

j) Can provoke hypermagnesemia with long-term use.


2. Fifth disease

True / False

a) Is caused by erythrovirus.

b) Has an incubation period of 2-10 days.

c) For women in the 2nd trimester of pregnancy, poses a risk of hydrops fetalis leading to spontaneous miscarriage.

d) May involve a pruritic body rash.

e) Can also cause a transitory arthritis.

f) Both face and body rash signify an infectious patient.

g) About one-third of the population has lifetime immunity from childhood infection.


3. Angular cheilitis

True / False

a) Is sometimes referred to as perlèche.

b) Should not be confused with angular stomatitis.

c) Sores are typically infected, but infection is usually not the first cause of the sores.

d) The most common pathogen is Staphylococcus epidermis.

e) Iron deficiency anemia is a common cause.

f) Vitamin A deficiency is another common cause.

g) Isotretinoin is a common treatment.


1. Proton pump inhibitors: a) False, up to 99%; b) True; c) True; d) True; e) True; f) True: half-life is 30-120 minutes, effect lasts 2-3 days; g) False, irreversibly-changed enzymes are naturally destroyed and replaced; h) True; i) True; j) False, can provoke hypomagnesemia.

2. Fifth disease: a) True, Parvovirus 19 is now called erythrovirus; b) False, it’s 4-21 days; c) False, 1st trimester is the danger period; d) True; e) True; f) False, once symptoms appear, transmission is rare; g) False, it’s between half and two-thirds.

3. Angular cheilitis: a) True; b) False, it’s the same thing; c) True; d) False; the commonest pathogen is Candida albicans; e) True; f) False, hypervitaminosis A is a cause of angular cheilitis, including excess consumption of cod liver oil and supplements; g) False, as a vitamin A analogue, isotretinoin increases risk of angular cheilitis.


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