Are proton pump inhibitors the first choice for acute treatment of gastric ulcers? A meta analysis of randomized clinical trials

Salas, Maribel; Ward, Alexandra; Jaime, J.

doi:10.1186/1471-230x-2-17

Cited by 67 publications

(34 citation statements)

References 20 publications

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“…Comment: We recommend PPIs because several metaanalyses demonstrated that the ulcer-healing rate of PPIs was significantly higher than that of H 2 RAs [48][49][50][51]. When PPIs cannot be prescribed due to allergy, for example, H 2 RAs are recommended.…”

Section: Non-eradication Therapymentioning

confidence: 99%

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

et al. 2016

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The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pyloripositive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

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Section: Non-eradication Therapymentioning

confidence: 99%

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

et al. 2016

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“…Optically active sulfoxides, [5][6][7][8][9][10] in general, represent an important class of pharmaceuticals and drug intermediates. [11] They often play an important role as therapeutic agents, such as anti-ulcer (proton pump inhibitors), [12][13][14][15][16] antibacterial, anti-atherosclerotic, [17][18][19] anthelmintic, [20] Adv. Synth …”

Section: Introductionmentioning

confidence: 99%

Mechanism of the Asymmetric Sulfoxidation in the Esomeprazole Process: Effects of the Imidazole Backbone for the Enantioselection

2009

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Abstract:The asymmetric sulfoxidation reaction of imidazole-based prochiral sulfides was studied to explore the mechanistic details of the highly efficient esomeprazole process, which is one of the few industrial scale catalytic asymmetric procedures. The synthetic studies revealed that the smallest subunit governing the selectivity in the esomeprazole process is an imidazole ring. Thus, by using the esomeprazole procedure methyl imidazole sulfide could be oxidized as efficiently as its several functionalized derivatives, including pyrmetazol. However, alkylation of the imidazole nitrogen led to a major drop of the enantioselectivity. Our atmospheric pressure chemical ionization-mass spectrometry (APCI/MS) studies indicate that addition of small amounts of water to the reaction mixture facilitates the formation of mononuclear titanium species, which are the active catalytic intermediates of the selective oxidation reaction. One of the most important features of the esomeprazole procedure is that amine additives increase the enantioselectivity of the oxidation process. The NMR studies of the presumed reaction intermediates show that under catalytic conditions the amines are able to coordinate to titanium and dissociate the coordinated imidazole substrate. The density functional theory (DFT) modelling studies provided new insights in the mechanism of the asymmetric induction. It was found that the oxidation requires a lower activation energy if the imidazole sulfide precursor does not coordinate to titanium. Two possible reaction paths were explored for this out of sphere oxidation mechanism. The most important interaction governing the enantioselection is hydrogen bonding between the N À H of the imidazole ring and the chiral tartrate ligand on titanium. Furthermore, the oxidation reaction imposes an important structural constraint to the TS structure involving a linear arrangement of the peroxide oxygens and the sulfur atom. This constraint and the N coordination of imidazole leads to a very strained structure for the inner sphere mechanism of the oxidation, which leads to a much higher activation barrier than the corresponding out of sphere process, and therefore it is unlikely.

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“…PPIs were also better than ranitidine in healing gastric ulcers-the pooled relative risk (RR) of all PPIs being 1.33 at 4 weeks-as evidenced in a meta-analysis of 16 trials [12]. They were also found to be better in Helicobacter pylori eradication as seen in a meta-analysis of twenty studies in which the eradication rates with PPIs or H 2 RAs plus antibiotics were 74% and 69%, respectively [13].…”

Section: Introductionmentioning

confidence: 91%

Proton pump inhibitors: use, misuse and concerns about long-term therapy

Rakesh

2011

Clin J Gastroenterol

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Proton pump inhibitors (PPIs) are widely used in acid-related disorders of the stomach and oesophagus. Treatment with PPIs is usually extended indefinitely for maintaining symptom control, putting the patient at risk of adverse effects. On the other hand, there is also a tendency for physicians to prescribe these drugs unnecessarily for minor dyspepsia. The use of these best-selling drugs is expected to increase further as they are now available over-the-counter in many countries . Several newer PPIs are now available on the market with claims of superior therapeutic efficacy which are also excessively prescribed without considering their cost-effectiveness. This article examines why PPIs are now the leading antisecretory drugs, clinical aspects to be considered when prescribing newer PPIs, indications and recommended duration of treatment in each situation, over-prescription of PPIs, and adverse reactions that can emerge with long-term use.

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Are proton pump inhibitors the first choice for acute treatment of gastric ulcers? A meta analysis of randomized clinical trials

Cited by 67 publications

References 20 publications

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

Mechanism of the Asymmetric Sulfoxidation in the Esomeprazole Process: Effects of the Imidazole Backbone for the Enantioselection

Proton pump inhibitors: use, misuse and concerns about long-term therapy

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