Drugs reducing the amount of acid made by the stomach. Proton Pump Inhibitors (PPIs) work by binding to protein pumps (hydrogen/potassium ATPase enzymes on gastric parietal cells) and blocking the secretion of hydrogen ions into the stomach, which combine with chloride ions in the stomach lumen to form gastric acid. PPIs are used to treat heartburn, gastroesophageal reflux disease (GERD), and gastric ulcers. Two most common uses of PPIs are treatment of dyspepsia and prevention of gastrointestinal bleeding among patients prescribed antiplatelet therapy.
Most heavily marketed brand-name PPIs are Prevacid (lansoprazole), Prilosec (omeprazole), and Nexium (esomeprazole). Compared to omeprazole, lansoprazole and pantoprazole, esomeprazole might be best in healing more severe cases of irritation/inflammation of the esophagus in the short term. Pantoprazole is less effective in treating reflex, but better for lessening the effect of antiplatelet therapies. FDA labeling recommends avoiding omeprazole and esomeprazole in patients taking clopidogrel.
The most common side effects of proton pump inhibitors include are headache, nausea, stomach pain, dry mouth, diarrhea, gas, constipation and drowsiness. Moderate side effects might be flu- or allergy-like, feelings of tightness in the chest and difficulty breezing.
Studies have shown PPIs to be associated with a twofold increase in the risk of Clostridium difficile colitis and a more than threefold increase in the risk of other enteric infections.
PPIs may also be associated with an increased risk of ambulatory pneumonia, although this association is subject to controversy.
Several observational studies have shown an association between long-term PPI use and fractures of both the hip and vertebrae, possibly due to achlorhydria, leading to mal-absorption and deficiencies of calcium and vitamin B12 and subsequent bone loss. Vitamin B12 deficiency is also associated with cognitive decline. Research revealed significant increase in risk of dementia with use of PPIs, especially in the 75-79 age group.
The most common side effects of proton pump inhibitors include are headache, nausea, stomach pain, dry mouth, diarrhea, gas, constipation and drowsiness. Moderate side effects might be flu- or allergy-like, feelings of tightness in the chest and difficulty breezing.
Studies have shown PPIs to be associated with a twofold increase in the risk of Clostridium difficile colitis and a more than threefold increase in the risk of other enteric infections.
PPIs may also be associated with an increased risk of ambulatory pneumonia, although this association is subject to controversy.
Several observational studies have shown an association between long-term PPI use and fractures of both the hip and vertebrae, possibly due to achlorhydria, leading to mal-absorption and deficiencies of calcium and vitamin B12 and subsequent bone loss. Vitamin B12 deficiency is also associated with cognitive decline. Research revealed significant increase in risk of dementia with use of PPIs, especially in the 75-79 age group.
