Proton Pump Inhibitors

Abstract

Proton pump inhibitors (PPIs) are drugs which irreversibly inhibit proton pump (H+/K+ ATPase) function and are the most potent gastric acid-suppressing agents in clinical use. There is now a substantial body of evidence showing improved efficacy of PPIs over the histamine H2 receptor antagonists and other drugs in acid-related disorders. Omeprazole 20 mg/day, lansoprazole 30 mg/day, pantoprazole 40 mg/day or rabeprazole 20 mg/day for 2 to 4 weeks are more effective than standard doses of H2-receptor antagonists in healing duodenal and gastric ulcers. Patients with gastric ulcers should receive standard doses of PPIs as for duodenal ulcers but for a longer time period (4 to 8 weeks). There is no conclusive evidence to support the use of a particular PPI over another for either duodenal or gastric ulcer healing. For Helicobacter pylori-positive duodenal ulceration, a combination of a PPI and 2 antibacterials will eradicate H. pylori in over 90% of cases and significantly reduce ulcer recurrence. Patients with H. pylori-positive gastric ulcers should be managed similarly. PPIs also have efficacy advantages over ranitidine and misoprostol and are better tolerated than misoprostol in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs). In endoscopically proven gastro-oesophageal reflux disease, standard daily doses of the PPIs are more effective than H2-receptor antagonists for healing, and patients should receive a 4 to 8 week course of treatment. For severe reflux, with ulceration and/or stricture formation, a higher dose regimen (omeprazole 40 mg, lansoprazole 60 mg, pantoprazole 80 mg or rabeprazole 40 mg daily) appears to yield better healing rates. There is little evidence that PPIs lead to resolution of Barrett's oesophagus or a reduction of subsequent adenocarcinoma development, but PPIs are indicated in healing of any associated ulceration. In Zollinger-Ellison syndrome, PPIs have become the treatment of choice for the management of gastric acid hypersecretion.

How Effective Is Extensive Nonsurgical Treatment of Patients with Clinically Active Crohn’s Disease of the Terminal Ileum in Preventing Surgery?

“…However, it could be speculated that with the new immunomodulating therapy for Crohn’s disease, it will be clear sooner whether nonsurgical management will be effective [14, 15]. …”

Potential Uses of Intravenous Proton Pump Inhibitors to Control Gastric Acid Secretion

“…In studies with oral formulations, all four members of the PPI family, omeprazole, lansoprazole, rabeprazole and pantoprazole, have been found to be of comparable efficacy in treatment of acid-related diseases such as GERD [42, 43]. Similarly, IV formulations of pantoprazole and omeprazole have proved equally effective in treating upper GI bleeding [6].…”

“…Similarly, IV formulations of pantoprazole and omeprazole have proved equally effective in treating upper GI bleeding [6]. These findings are not surprising, given that all PPIs act through the same mechanism, inhibition of the parietal cell H + K + -ATPase [43]. …”

Aluminium-eriochrome Cyanin R, A Novel Chromogen for the Spectrophotometric Determination of Pentoprazole Sodium

“…It works on gastric parietal cells to irreversibly inhibit (H+/K+)-ATP functions and suppresses the production of gastric acid. 1,2 Adverse effects of pentoprazole include pneumonia, 3 abdominal pain, diarrhea, flatulence, nausea, vomiting headache, dizziness, arthralgia , dry mouth, low white blood cell count, interstitial nephritis, Stevens-Johnson syndrome. 1 Osteoporosis and bone fracture have been observed in patients on high-dose and/or long term prescription proton pump inhibitors.…”