Proton-pump inhibitors treatment

Effective treatment of reflux disease has greatly reduced the need for anti-reflux surgery although the case for it remains in young people with persistent symptoms, and where responses to pharmacotherapy are poor. Endoscopic oesophageal dilatation with maintenance proton pump inhibitor treatment usually obviates the need for surgical reconstruction of the lower oesophagus in individuals with visible inflammation at endoscopy. 

Leontiadis GI, Sharma VK, Howden CW. Systematic review and meta-analysis proton pump inhibitor treatment for ulcer bleeding reduces transfusion requirements and hospital stay-results from the Cochrane Collaboration. Aliment Pharmacol Ther 2005 22 169-74. 

PROTON PUMP INHIBITORS CLOPIDOGREL Patients after myocardial infarction on dopidogrel were more likely to suffer reinfarction with concomitant proton pump inhibitor treatment Proton pump inhibitors inhibit CYP2C19, which converts dopidogrel to the active metabolite Pantoprazole is not known as yet to cause this effect. Consider using acid suppression therapy with H2 blockers when dopidogrel is used as secondary prevention of coronary heart disease... 

PROTON PUMP INHIBITORS IRON 1 plasma concentrations of iron Proton pump inhibitors inhibit the absorption of iron Consider use of parenteral iron in patients on proton pump inhibitors treatment... 

Loss of gastric acidity from chronic proton pump inhibitor treatment may affect the bioavailability of such drugs as ketoconazole, ampicillin esters, and iron salts. Chronic therapy, with proton pump inhibitors has been linked to increased frequency of hip fractures, possibly secondary to decreased absorption of calcium. 

Omeprazole Prilosec Nexium (Mg salt) Losec Mepral Proton pump inhibitor Treatment of peptic ulcer, dyspepsia, and 9 ... 

Antacids are neutralizing agents. Examples are magnesium hydroxide, magnesium trisylicate and aluminium hydroxide. Prior to the introduction of histamine-H2 receptor antagonists and proton pump inhibitors, they were the standard drugs for the treatment of duodenal/ peptic ulcers. Today their clinical use is limited to the treatment of dyspepsia and the symptomatic relieve for patients with peptic ulcers. 

Shin JM, Sachs G (2002) Restoration of acid secretion following treatment with proton pump inhibitors. Gastroenterology 123 1588-1597... 

The proton pump inhibitors are particularly important in the treatment of Helicobacter pylori in patients with active duodenal ulcers. Helicobacter pylori (H. pylori) has been implicated as a causative organism in a type of chronic gastritis and in a large number of cases of peptic and duodenal ulcers. 

The proton pump inhibitors are used for treatment or symptomatic relief of various gastric disorders, including gastric and duodenal ulcers, GERD, or pathological hypersecretory conditions. Painful, persistent heartburn 2 or more days a week may indicate acid reflux disease which can erode the delicate lining of the esophagus,... 

Less common causes of peptic ulceration include Zollinger-Ellison syndrome (ZES), cancer chemotherapy, radiation, and vascular insufficiency. ZES is caused by a gastrin-producing tumor called a gastrinoma and results in gastric acid hypersecretion. High-dose oral proton pump inhibitor (PPI) therapy is the initial treatment of choice for ZES intermittent intravenous PPI therapy may be required for any patient in whom oral therapy is contraindicated.1... 

FIGURE 55-2. Treatment of osteoarthritis. OA, osteoarthritis COX-2, cyclooxygenase-2 CV, cardiovascular Gl, gastrointestinal, IA, intraarticular NSAID, nonsteroidal anti-inflammatory drug PPI, proton pump inhibitor. 

Polymorphisms of CYP2C19 cause differences in metabolism of omeprazole, a proton pump inhibitor used for treatment of gastroduodenal ulcers or reflux esophagitis. Such polymorphisms result in resistance to treatment at a standard dose regimen in nearly 20% of European Caucasians, and in an even higher percentage of Asians [12]. 

In healthy individuals URT flora multiplies in gastric aspirate during treatment with antisecretory compounds and in particular proton pump inhibitors [34, 40, 44], This concerns viridans streptococci, coagulase-negative staphylococci, Haemophilus sp., diphtheroids, Moraxella sp., lactobacilli, and other streptococci, most of which are Gram-positive bacteria. With dedicated measures anaerobic species of oral origin are also recovered [66]. 

FIGURE 28-2. Algorithm of guidelines for the treatment of pancreatic steatorrhea in chronic pancreatitis. (C, capsule ECMS, enteric-coated microsphere ECMT, enteric-coated microtablet ECS, enteric-coated sphere H2RA, histamine-2 receptor antagonist P, powder PPI, proton pump inhibitor UCT, uncoated tablet.)... 

Jai Moo Shin and G. Sachs, Restoration of Acid Secretion Following Treatment with Proton Pump Inhibitors, Gastroenterology, 2002, 123, 1588-97. 

Omeprazole (p. 167) can cause maximal inhibition of HCl secretion. Given orally in gastric juice-resistant capsules, it reaches parietal cells via the blood. In the acidic milieu of the mucosa, an active metabolite is formed and binds covalently to the ATP-driven proton pump (H+/K+ ATPase) that transports H+ in exchange for IC into the gastric juice. Lansoprazole and pantoprazole produce analogous effects. The proton pump inhibitors are first-line drugs for the treatment of gastroesophageal reflux disease. 

H2-receptor antagonists are drugs used to block the action of histamine on parietal cells in the stomach, decreasing acid production by these cells. These drugs are used in the treatment of dyspepsia however, their use has waned since the advent of the more effective proton pump inhibitors. 

Lazzaroni M, Bianchi Porro G. Treatment of peptic ulcer in the elderly. Proton pump inhibitors and histamine H2 receptor antagonists. Drugs Aging 1996 9(4) 251-61. 

The addition of proton pump inhibitors (PPIs) to treatment with conventional NSAIDs is probably the most cost-effective alternative for the prevention of gastrointestinal events. Addition of misoprostol is also a well-documented prophylactic routine. 

Il.b.l.1. Adverse effects of anti-secretory treatment. Histamine H2 antagonists and proton pump inhibitors are very safe as well as effective treatments. Cimetidine has small effects on hepatic drug metabolism which are only of clinical signiflcance with drugs used in doses close to toxic levels, notably phenytoin, aminophylline and warfarin. Other adverse effects such as headache, rash and thrombocytopenia are rare. 

Anti-secretory treatment, by reducing the acid barrier to infection approximately doubles the risk of infective diarrhoea. Fears that treatment like H2 receptor antagonists or proton pump inhibitors would increase the risk of gastric cancer have not been realised. Raised frequencies of oesophageal cancer in patients taking proton pump inhibitors reflect underlying predisposition in Barrett s disease. 

A. If the precipitant can be withdrawn then an-tisecretory treatment with a histamine H2 antagonist or proton pump inhibitor, or misoprostol (an antisecretory and mucosally protective prostaglandin) for a month may be enough to induce ulcer healing. 

A 57-year-old man with extensive onychomycosis (fungal toenail infection) asks you for an evaluation. He requests a prescription for itraconazole for treatment of this problem after seeing a television advertisement for this drug. He has chronic heartburn attributed to gastroesophageal reflux disease and is treated with the proton pump inhibitor omeprazole. He is taking lovastatin for treatment of... 

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