Clinical Efficacy of Esomeprazole in the Prevention and Healing of Gastrointestinal Toxicity Associated with NSAIDs in Elderly Patients

Abstract

NSAIDs are widely prescribed for the treatment of pain, inflammation and rheumatic disorders, but their use is associated with adverse gastrointestinal effects, ranging from dyspeptic symptoms and peptic ulcers to more serious complications. Elderly patients are at high risk of experiencing NSAID-induced gastrointestinal tract injury and should be considered candidates for prophylactic pharmacological therapy. In studies conducted in adult patients, proton pump inhibitors (PPIs) such as esomeprazole have been shown to prevent or reduce NSAID-induced gastrointestinal injury. The beneficial effects of esomeprazole can be ascribed largely to its ability to maintain sustained inhibition of gastric acid secretion, although there is evidence to suggest that pharmacodynamic properties unrelated to acid inhibition may also contribute to the gastroprotective effects of this agent. Although there are limited data on the use of esomeprazole specifically in elderly patient populations, studies of patients at high risk of NSAID-induced gastrointestinal toxicity because of advanced age indicate that this PPI is both effective and well tolerated when administered in conjunction with NSAIDs. Thus, esomeprazole can be regarded as a useful option for prophylactic therapy in elderly patients receiving long-term NSAID therapy.

Pharmacological Management of Persistent Pain in Older Persons

“…Whether an NSAID prescribed along with a proton pump inhibitor or monotherapy with a COX‐2 selective inhibitor provides superior protection from incident dyspepsia, bleeding, or other gastrointestinal tract complications remains unclear 68,69 . In individuals at high risk for recurrent gastrointestinal bleeding or ulceration, some evidence highlights the benefits of co‐administration of a proton pump inhibitor with a COX‐2 inhibitor 70,71 …”

Interaction of omeprazole and Helicobacter pylori-induced nuclear factor-κB activation and mediators in gastric epithelial cells

“…Furthermore, OMP appears to have a wide therapeutic range, in that it not only inhibits acid secretion, 30,31 but also may possess anti-inflammatory 20 and anticancer properties 22 ; however, its underlying molecular mechanisms remain unclear. The mechanisms by which OMP suppresses gastric acid secretion have been shown to be dependent on its inhibition of the H þ /K þ ATPase present on the membrane of gastric parietal cells, and subsequent inhibition of H þ release.…”

Pathophysiology of Gastric Ulcer Development and Healing: Molecular Mechanisms and Novel Therapeutic Options

“…Several preclinical and clinical lines of evidence have demonstrated that PPIs are highly effective in promoting the healing of gastric damage induced by NSAIDs, even in the www.intechopen.com presence of a continued NSAID administration, through the activation of both aciddependent and -independent mechanisms (Blandizzi et al, 2008). PPIs are substituted benzimidazole derivatives (Figure 3) endowed with potent inhibitory effects on gastric acid secretion.…”