Abdominal pain proton pump inhibitors

The most common adverse reactions seen with the proton pump inhibitors include headache, diarrhea, and abdominal pain. Other less common adverse reactions include nausea, flatulence, constipation, and dry mouth. 

Localised upper abdominal pain is the most common symptom of peptic ulcer disease. The pain is relieved by antacids, proton pump inhibitors and H2 antagonists. The pain may or may not be relieved by food and is often v/orse during the night. Peptic ulceration may be accompanied by occasional vomiting, anorexia and weight loss. Diffuse abdominal pain is not a characteristic symptom of peptic ulcer disease. 

Proton pump inhibitors are extremely safe. Diarrhea, headache, and abdominal pain are reported in 1-5% of patients, although the frequency of these events is only slightly increased compared with placebo. Proton pump inhibitors do not have teratogenicity in animal models however, safety during pregnancy has not been established. 

In practice, a minority of patients are intolerant of aU NSAIDs. They may benefit from the co-administration of a proton pump inhibitor, a 112-receptor blocker or the prostaglandin analogue, misoprostol. To address this problem, some NSAIDs are presented in combination with misoprostol, e.g. diclofenac with misoprostol (Arthrotec) and naproxen with misoprostol (Napratec). Some patients experience abdominal pain and diarrhoea from the misoprostol component. 

Esomeprazole is the 5-isomer of omeprazole. The pharmacology, pharmacokinetics, efficacy, and safety of esomeprazole have been reviewed (1). Esomeprazole produces acid control comparable to that of currently available proton pump inhibitors. It undergoes less hepatic metabolism than omeprazole, has an oral availability of 89% at a dose of 40 mg, and a half-life of 1.5 hours. Esomeprazole is well tolerated its common adverse effects are diarrhea, headache, nausea, abdominal pain, respiratory infection, and sinusitis. 

Lansoprazole is a proton pump inhibitor. Its safety profile has been reviewed based on premarketing chnical studies, and has to be regarded with the reservations appropriate to this type of material. In 4749 patients the most frequent adverse effects were headache (4.7%), diarrhea (3.2%), abdominal pain (2.2%), pharyngitis (1.8%), and nausea (1.4%) some patients had upper respiratory complaints or suffered anxiety or depression, or myalgia (1). The adverse reaction profile appears to be closely similar to that of omeprazole. 

The clinical and fiscal impact of replacing omeprazole with lansoprazole as the only proton pump inhibitor has been assessed by reviewing the medical records of 3833 patients requiring long-term proton pump inhibitor therapy (2224 were started on lansoprazole and 1479 were converted from omeprazole to lansoprazole) (13). There were considerable pharmaceutical savings. The true lansoprazole failure rate (requiring conversion to omeprazole) was 5.3%. Withdrawal of lansoprazole was due to poor symptom control (in 69%) and/or adverse effects (in 22%). The most common adverse effects were diarrhea (10%), abdominal pain (5%), and urticaria (1%). 

The adverse effects profile of the proton pump inhibitors during short-term administration (under 12 weeks) is similar to that reported with short-term use of histamine receptor antagonists. The type and frequency of adverse effects reported with lansoprazole, omeprazole, pantoprazole, and rabeprazole are comparable. The most common adverse effects include headache, diarrhea, nausea, abdominal pain, constipation, dizziness, and skin rashes. 

The severity and frequency of abdominal pain should be assessed periodically in order to determine the efficacy of the patient s pain control regimen. Most patients with abdominal pain can be adequately controlled with acetaminophen, NSAIDs, or selective COX-2 inhibitors. A trial of pancreatic enzymes and either an H2-receptor antagonist or proton pump inhibitor may relieve pain in patients with mild to moderate disease. Patients with severe pain will require narcotics. In these patients, pain should be monitored daily and medications adjusted accordingly. Some patients will require endoscopic therapy or pancreatic surgery. 

---