Prevalência de alterações proliferativas gástricas em pacientes com uso crônico de inibidores de bomba de prótons

Abstract

DESCRITORES -Inibidores da bomba de prótons. Mucosa gástrica. Pólipos. ABSTRACT -Background -The medications most often prescribed and used chronically by patients with dyspeptic symptoms belong to the group of inhibitors of proton pump whose main representative is omeprazole, used clinically about 20 years. Recent studies have postulated the relationship between chronic use of this medication and macroscopic and microscopic proliferative changes in mucosal of gastric body, especially the fundic gland polyps. Aim -To analyze the frequency and type of gastric proliferative changes in chronic users of proton pump inhibitors proton and its association with age, dose, time of use, symptoms and Helicobacter pylori infection. Methods -A survey of prevalence was conducted in Digestive Endoscopy Service, Hospital de Clínicas, Federal University of Paraná, using questionnaire referring the use of these drugs and performed in subjects using this class of drugs during at least 12 months prior to the endoscopy. Gastric biopsies of fundus, body and antrum were performed in all patients. Polyps were removed when present for histopathological analysis. Research on Helicobacter pylori was done by urease test and histopathology. RESUMO -RacionalResults -Twenty-two individuals were included of which six (27.3%) had proliferative changes of the mucosa. Of these, two (9.1%) had sporadic fundic polyps and four only microscopic proliferative change as cystic glandular formation. Statistic significant (p <0.05) association between age ≥ 60 years and these changes was found. There was no association between dose of use, time of use, symptoms and Helicobacter pylori infection. Conclusions -It was observed the existence of proliferative mucosa changes in individuals with chronic use of inhibitors of proton pump. In this group, the association between age and proliferative changes was significant.

Endoscopic and Histopathologic Gastric Changes in Chronic Users of Proton-Pump Inhibitors

“…Many prescriptions are improperly given to hospitalized patients and maintained after discharge, necessitating a more appropriate definition for PPI use (14) . In our study, the age band and the distributions by sex and skin color were similar to those described in the literature (15,20) . As the patient's age increases, he or she is more likely to have comorbidities and to be using other medications, thus increasing the risk of side effects.…”

“…Parietal cell hyperplasia, protrusion of the parietal cells in the lumen to the oxyntic glands, and cystic gland formation were among the described microscopic changes. The most common macroscopic change was the formation of sporadic fundic polyps that, rarely, were dysplastic (15) . The literature describes a relationship between the duration of PPI use and the risk of polyps, especially when PPIs are used for more than 12 months.…”

Análise qualitativa das alterações anatomopatológicas na mucosa gástrica decorrentes da terapêutica prolongada com inibidores da bomba de prótons: estudos experimentais x estudos clínicos

“…Furthermore, researches show that the long term use of this medicine is associated to the increase of the incidence of atrophic chronic gastritis, a precursory condition for stomach cancer 1,16,31,32 . Jalving et al (2006) demonstrated that the continued use of PPIs promotes the appearance of fundic hyperplastic polyps, which was also identified by Menegassi et al in 2010. In this last study these findings prevailed on patients over 60 years of age, which could be explained by the longer use of the medicine 22 .…”

“…Jalving et al (2006) demonstrated that the continued use of PPIs promotes the appearance of fundic hyperplastic polyps, which was also identified by Menegassi et al in 2010. In this last study these findings prevailed on patients over 60 years of age, which could be explained by the longer use of the medicine 22 .…”

Interações medicamentosas potenciais em pacientes ambulatoriais

“…Outro mecanismo, talvez menor, é a inibição competitiva da biotransformação pelo CYP450 3A4, aumentando os níveis plasmáticos da sinvastatina 13 . [15][16][17] . Neste sentido, outros inibidores de bomba de prótons, ou antagonistas de histamina 2 podem ser opções válidas para evitar consequências adversas 18,19 .…”