Acid-peptic disease proton pump inhibitors

Proton pump inhibitors (PPIs), such as omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole, are commonly prescribed to treat symptoms of heartburn, acid reflux, chest pain, dyspepsia, and chronic cough. PPIs inhibit the transfer of protons into the stomach lumen. Pharmacological acid suppression is thus used to treat gastroesophageal reflux disease (GERD) and esophagitis, peptic ulcers, and Helicobacter pylori infection as well as to prevent ulcer development with concurrent nonsteroidal anti-inflammatory drug use. 

Proton pump inhibitors (PPIs), eg, omeprazole, lansoprazole Irreversible blockade of H +, K+-ATPase pump in active parietal cells of stomach Long-lasting reduction of stimulated and nocturnal acid secretion Peptic ulcer, gastroesophageal reflux disease, erosive gastritis Half-lives much shorter than duration of action low toxicity reduction of stomach acid may reduce absorption of some drugs and increase that of others... 

The results of a therapeutic interchange program, in which 78 patients with acid peptic disease requiring proton pump inhibitor therapy (both newly diagnosed patients and those previously stabilized on omeprazole) were treated with lansoprazole, have been retrospectively analysed (12). Although the switch was associated with considerable pharmaceutical savings, there was an overall lansoprazole-associated failure rate of 28%. Reported lack of efficacy required withdrawal of lansoprazole in 15%, while adverse effects required withdrawal of lansoprazole in 13% of patients (versus none with omeprazole). The main adverse effect was diarrhea. 

Brunner G, Athmann C, Boldt JH. Reversible pheripheral edema in female patients taking proton pump inhibitors for peptic acid diseases. Dig Dis Sci 2001 46(5) 993-6. 

Acid peptic disease (overall less effective than proton pump inhibitors), gastroesophageal reflux dystrophy (GERD), Zollinger-Ellison syndrome. 

The Hj receptor antagonists were the first truly effective drugs for the therapy of acid-peptic disease, and their long history of safety and efficacy with the eventually led to their avaUabihty without a prescription. Increasingly, proton pump inhibitors (some also available OTC) are replacing the Hj receptor antagonists in cUnical practice. 

It is a happy accident that the introduction H. pylori therapy and the introduction of the first proton pump inhibitor (PPI) omeprazole coincided. Instead of the expected battle of two controversial approaches to curing peptic ulcer disease - either H. pylori eradication with antibiotics or potent acid suppression by PPIs - they merged in a single strategy for healing ulcers. 

---