Proton-pump inhibitors (PPIs) are one of the most active ingredients prescribed in Spain. In recent decades there has been an overuse of these drugs in both outpatient clinics and hospitals that has lead to a significant increase in healthcare spending and to an increase in the risk of possible side effects. It is important for health professionals to know the accepted indications and the correct doses for the use of these drugs. On the market there are different types of PPI: omeprazole, pantoprazole, lansoprazole, rabeprazole and esomeprazole. Omeprazole is the oldest and most used PPI, being also the cheapest. Although there are no important differences between PPIs in curing diseases, esomeprazole, a newgeneration PPI, has proved to be more effective in eradicating H. pylori and in healing severe esophagitis compared to other PPIs. In recent years the use of generic drugs has spread; these drugs have the same bioavailability than the original drugs. In the case of PPIs, the few comparative studies available in the literature between original and generic drugs have shown no significant differences in clinical efficacy.Key words: Proton-pump inhibitor. PPI. Omeprazole. Pantoprazole. Lansoprazole. Rabeprazole. Esomeprazole. INTRODUCTIONProton-pump inhibitors (PPIs) represent a family of drugs widely used in our country. The advent in the nineties of PPIs was a great revolution in the treatment of ulcer disease and gastroesophageal reflux. The main problems of PPIs at present time are its overuse and the errors in the therapeutic indication. This fact leads to a considerable health economic cost and the risk of long-term side effects. In this review the main problems of PPIs prescription, their indications, the differences between PPIs and tips on their use are discussed. Brief historical memory: since alkaline diets until PPIsThe treatment of ulcer disease and gastroesophageal reflux disease (GERD) in the early twentieth century was the prescription of alkaline foods like milk, eggs and puree (1). Later, there were products as sodium bicarbonate that improved symptoms but did not prevent complications. Surgical treatment consisted of different types of gastric surgeries for peptic ulcer disease and Nissen fundoplication for GERD (2).In the mid twentieth century the use of muscarinic antagonists was introduced, atropine being its main active ingredient. Acids secretion was partially inhibited by blocking the muscarinic receptor of the parietal cell. However, these drugs had little effectiveness and numerous adverse effects due to the amount of muscarinic receptors distributed throughout the body. E-type prostaglandin was discovered later, but, again, the limitations of these substances were their short half life and side effects. An important progress in gastric antisecretory therapy was the appearance of H 2 receptors antagonists (H 2 blockers) (3). The most used were ranitidine and famotidine. These drugs established a substantial change by blocking the action of histamine receptor in gastric parietal ...
Introduction Endoscopic papillary large balloon dilatation (EPLBD) is an alternative for the treatment of common bile duct (CBD) stones. Existing evidence of factors associated with its outcomes is contradictory. Objective To identify predictors (including the experience of an endoscopist) of success and adverse events in EPLBD. Methods We reviewed the first 200 EPLBD with endoscopic sphincterotomy (EST) performed at our center. Demographic, clinical, and anatomic variables were studied, as well as the performance characteristics, correlating them with individual and group experience. Results Global success was obtained in 87% of cases, and adverse events occurred in 16% of cases. Success was associated with stone size, CBD diameter, and the need to perform mechanical lithotripsy (ML). Despite that adverse events were not univariately associated with any factor, severe adverse events were more likely to occur in stones > 13.5 mm. Multivariate analysis which disclosed success was higher when ML was not required and stones were < 13.5 mm. It also showed that no factor was associated with adverse events or their severity. No differences were found on success or adverse events that could be directly related to experience. Conclusions Success of EPLBD-EST is higher in stones < 13.5 mm and when ML is not required. Experience does not appear to play a major role.
INFORMACIÓN AL PACIENTEAunque se ha puesto el máximo cuidado en la elaboración de estos textos, los autores, coordinadores y la propia Revista Española de Enfermedades Digestivas, recuerdan que no sustituyen a la opinión y consejo de un médico y que no se hacen responsables de las decisiones tomadas basándose en los mismos.Corte y fotocopie esta hoja y úsela para informar a sus pacientes 1130-0108/2014/106/2/145 Revista española de enfeRmedades digestivas CopyRight © 2014 aRán ediCiones, s. l.Rev esp enfeRm dig (Madrid Vol. 106, N.º 2, pp. 145, 2014 INFORMACIÓN AL PACIENTE ¿QUÉ ES?El hígado, al contrario que otros órganos, recibe un doble aporte de sangre, uno a través de la arteria hepática y otro por la vena porta. La vena porta es el principal vaso sanguíneo encargado de conducir la sangre procedente del intestino y el bazo hasta el hígado, donde llevará los nutrientes que han sido absorbidos tras la digestión de los alimentos. Para que estos y otras sustancias puedan llegar a todas las células, la vena porta se divide en pequeños vasos hasta formar los llamados sinusoides hepáticos, de finas paredes y en contacto con las células del hígado. De ahí, la sangre debe abandonar el hígado para llegar al corazón. Para ello, los sinusoides se unen y forman unos vasos sanguíneos de mayor calibre y a su vez la unión de estos, dará lugar a tres grandes venas, llamadas venas suprahepáticas. Estas venas son las encargadas de llevar la sangre hasta la vena más grande del cuerpo: la vena cava, que trasportará la sangre hasta el corazón.La presión en la vena porta es baja, hecho que permite que el flujo de sangre mantenga una dirección y sentido hacia el hígado. En los pacientes con cirrosis, la fibrosis y otros fenómenos generados en el hígado puede dificultar el paso de la sangre a través de los pequeños vasos, de manera que aumenta la presión en la vena porta, hecho que conocemos como hipertensión portal.Sin embargo, en una minoría de pacientes se puede elevar la presión en la vena porta sin que exista enfermedad alguna en las células del hígado, es lo que conocemos como hipertensión portal no cirrótica (HPNC). ¿CUÁLES SON SUS CAUSAS?La causa más importante por la que se produce un aumento de la presión en la vena porta sin una enfermedad hepática que produzca fibrosis es la obstrucción del flujo sanguíneo que llega o sale del hígado. Lo más frecuente es que la obstrucción se produzca en la propia vena porta, como ocurre si se forma un trombo en su interior. Sin embargo, el flujo puede interrumpirse o disminuir en los pequeños vasos venosos antes de que se formen los sinusoides, como ocurre cuando hay contacto con unos extraños parásitos llamados Schistosoma; o bien a nivel de los sinusoides hepáticos, por pequeños trombos que ocluyen la luz; o incluso en las grandes venas suprahepáticas o la vena cava, fenómeno que se conoce con el nombre de síndrome de Budd Chiari y que normalmente se acompaña de dolor en la parte derecha del abdomen.Muchos pacientes que padecen HPNC presentan otras enfermedades que pueden favorec...
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