Efectos adversos a largo plazo de los inhibidores de la bomba de protones. Perspectiva desde la medicina basada en la evidencia

Abstract

ResumenLos inhibidores de la bomba de protones (IBP) son los supresores de la secreción gástrica más efectivos y se encuentran entre los medicamentos de mayor formulación y venta en Estados Unidos; en algunos casos son prescritos sin indicación justificada. En años recientes, el reporte de reacciones adversas importantes relacionadas con su uso ha suscitado preocupación. Sin embargo, la calidad de la evidencia no ha sido concluyente y, en algunos casos, la magnitud del riesgo no es de importancia clínica. El objetivo de esta revisión es presentar la evidencia disponible frente a los eventos adversos de mayor importancia relacionados con los IBP. Palabras claveInhibidores de la bomba de protones, efectos colaterales y reacciones adversas relacionadas con medicamentos, medicina basada en evidencia, farmacovigilancia (fuente: DeCS). AbstractProton pump inhibitors (PPIs) are the most effective gastric secretion suppressors and are among the most widely prescribed and widely available drugs in the United States of America. In some cases they are prescribed without justification. In recent years, concerns have arisen over reports of major adverse reactions related to the use of PPIs. However, the quality of the evidence has not been conclusive, and in some cases the magnitude of the risk has not been clinically significant. The objective of this review is to present the available evidence regarding the most important adverse events related to PPIs. KeywordsProton pump inhibitors, adverse drug side effects, adverse drug reactions, evidence-based medicine, pharmacovigilance (Source: DeCS). Revisión de tema INTRODUCCIÓNLos inhibidores de la bomba de protones (IBP) son medicamentos supresores de la secreción gástrica que actúan mediante la inhibición de H + K + -ATPasa en las células parietales del cuerpo y el fondo gástrico. Son profármacos que al ser ingeridos pasan a la circulación general y se difunden por las membranas de las células parietales hasta los canalículos, en donde el pH ácido (alrededor de 0,8) induce la formación de una sulfonamida tetracíclica que se une covalentemente con los grupos sulfidrilo de los aminoáci-dos cisteína en la H + K + -ATPasa inactivándola irreversiblemente e inhibiendo la secreción ácida gástrica hasta que nuevas bombas de protones son sintetizadas. Actualmente hay disponibles cinco IBP en el mercado: omeprazol, esomeprazol, lansoprazol, pantoprazol y rabeprazol, los cuales

Drugs With Anticholinergic Potential and Risk of Falls With Hip Fracture in the Elderly Patients: A Case–Control Study

“…37,38 However, given the presence of proton pumps in osteoclasts, a reduction in bone resorption due to an inhibitory effect of the drug is also possible. 38 The meta-analysis by Kwok et al confirmed that there was an increased risk of fracture, especially in the lumbar spine, after using PPIs. 39 van der Hoorn et al, in a cohort study of elderly Australian women, documented elevated risks of osteoporosis (adjusted subhazard ratio [SHR]: 1.28, 95% CI: 1.13-1.44) and fracture (SHR: 1.29, 95% CI: 1.08-1.55), mainly with esomeprazole and rabeprazole.…”

“…Proton pump inhibitors were associated with an increased risk of hip fracture in this population, which is concerning, as these drugs are among the most widely prescribed worldwide, with increasing evidence of their potentially deleterious effects on bone due to altered gastric acidity and prevention of the correct ionization and absorption of Ca 2+ , which may lead to hypocalcemia and secondary hyperparathyroidism. 37,38 However, given the presence of proton pumps in osteoclasts, a reduction in bone resorption due to an inhibitory effect of the drug is also possible. 38 The meta-analysis by Kwok et al confirmed that there was an increased risk of fracture, especially in the lumbar spine, after using PPIs.…”

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“…Cardona Ospina et al 20 show a possible higher risk for enteric infections (Salmonella spp., Campylobacter jejuni, Escherichia coli, Clostridium difficile, Vibrio cholerae and Listeria spp.) 21 with the use of PPIs (especially CDI), despite heterogeneity between outcomes and variable interactions such as antibiotic use.…”

Evaluation of CYP2C19 Gene Polymorphisms in Patients with Acid Peptic Disorders Treated with Esomeprazole

“…PPIs modify chloride acid production by irreversibly inhibiting H/K-ATPase on parietal cells. 2 There are currently five PPI drugs commercially available: omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole, which have very similar pharmacological properties.…”