Proton pump inhibitor treatment

Česká verzia

Authors: J. Špičák
Authors place of work: Klinika hepatogastroenterologie, Institut klinické a experimentální medicíny, Praha
Published in the journal: Kardiol Rev Int Med 2014, 16(3): 214-218
Category: Internal Medicine

Summary

PPIs are weak bases metabolized in an acid environment and blocking the function of active proton pumps. They provide effective treatment for oesophageal reflux disease, Helicobacter pylori infection, functional dyspepsia and non‑steroidal anti‑inflammatory drug‑induced gastropathy. The first generation includes omeprazole, pantoprazole and lansoprazole; the second one consists of esomeprazole and rabeprazole. The pharmacokinetic differences between different PPIs do not always result in relevant clinical consequences. Generally, the second generation PPIs provide a more rapid effect and a more prolonged inhibition of the gastric secretion. The effect of rabeprazole, especially, is less dependent on the method of administration and has a lower influence on the cytochrome P450 function. The effectiveness of first‑ generation PPIs is influenced by the genetic variability of the CYP2C19 enzyme, being significantly lower in rapid metabolizers. PPIs are very safe and immediate complications are exceptional. In Helicobacter pylori infection they cause a worsening of gastritis. Although PPIs cause hypergastrinaemia, they do not exhibit any malignant potential. Their long‑term administration is associated with an increased risk of spine and hip fractures, community pneumonia and clostridium bowel infection. They can lower the effectiveness of antiplatelet therapy with clopidogrel, with a consequent increased risk of cardiovascular events.

Keywords:
proton pump inhibitors – histamine- 2 receptor antagonists – gastric secretion physiology – equipotency – oesophageal reflux disease – Helicobacter pylori eradication – non‑steroid anti‑inflammatory drug‑induced gastropathy – complications – interactions

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