Does long-term medication with a proton pump inhibitor induce a tolerance to H2 receptor antagonist?

Hashimoto, Hiroshi; Kushikata, Tetsuya; Kudo, M; Hirota, Kazuyoshi

doi:10.1007/s00535-006-1946-3

Cited by 5 publications

(1 citation statement)

References 20 publications

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“…If neither are given, most of patients would have a high risk of acid aspiration pneumonia during the induction of anesthesia as we previously found that patients without prophylaxis showed low gastric pH (2.2 ± 1.2) and high volume (20 ± 18 mL). (16) In addition, the chief GI complication following CPB is GI bleeding secondary to gastric or duodenal ulceration. (17) Therefore, perioperative gastric acid suppression is necessary.…”

Section: Discussionmentioning

confidence: 99%

A marked increase in gastric fluid volume during cardiopulmonary bypass

Hirota

Kudo

Hashimoto

et al. 2011

J. Clin. Biochem. Nutr.

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Major physiological stress occurs during cardiac surgery with cardiopulmonary bypass. This is related to hypothermia and artificial organ perfusion. Thus, serious gastrointestinal complications, particularly upper gastrointestinal bleeding, sometimes follow cardiac surgery. We have compared the antisecretory effects of a preanesthetic H2 antagonist (roxatidine, cardiopulmonary bypass-H2 group, n = 15) and a proton pump inhibitor (rabeprazole, cardiopulmonary bypass-PPI group, n = 15) in patients undergoing cardiac surgery with cardiopulmonary bypass, and also compared in patients undergoing a off-pump coronary artery bypass graft surgery (off-pump cardiopulmonary bypass-H2 group, n = 15). Gastric pH (5.14 ± 0.61) and gastric fluid volume (13.2 ± 2.4 mL) at the end of surgery in off-pump cardiopulmonary bypass-H2 groups was significantly lower and higher than those in both cardiopulmonary bypass-H2 (6.25 ± 0.54, 51.3 ± 8.0 mL) and cardiopulmonary bypass-PPI (7.29 ± 0.13, 63.5 ± 14.8 mL) groups, respectively although those variables did not differ between groups after the induction of anesthesia. Plasma gastrin (142 ± 7 pg/mL) at the end of surgery and maximal blood lactate levels (1.50 ± 0.61 mM) in off-pump cardiopulmonary bypass-H2 group were also significantly lower than those in both cardiopulmonary bypass-H2 (455 ± 96 pg/mL, 3.97 ± 0.80 mM) and cardiopulmonary bypass-PPI (525 ± 27 pg/mL, 3.15 ± 0.44 mM) groups, respectively. In addition, there was a significant correlation between gastric fluid volume and maximal blood lactate (r = 0.596). In conclusion, cardiopulmonary bypass may cause an increase in gastric fluid volume which neither H2 antagonist nor PPI suppresses. A significant correlation between gastric fluid volume and maximal blood lactate suggests that gastric fluid volume may predict degree of gastrointestinal tract hypoperfusion.

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Section: Discussionmentioning

confidence: 99%

A marked increase in gastric fluid volume during cardiopulmonary bypass

Hirota

Kudo

Hashimoto

et al. 2011

J. Clin. Biochem. Nutr.

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Gastrointestinal Disorders: A Focus on Acid‐Suppressive Agents

Hemstreet

2011

Pharmaceutical Sciences Encyclopedia

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Acid‐related disorders are prevalent in many countries. Research over the last century into the physiology of gastric acid secretion has yielded valuable insight into pathophysiology of many of these disorders. The discovery that histamine, gastrin, and acetylcholine all effect the production of gastric acid paved the way for the development of the H2RAs and PPIs. These agents have subsequently revolutionized the treatment of many acid‐related disorders in clinical practice.

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Effects of oral rehydration therapy on gastric volume and pH in patients with preanesthetic H2 antagonist

Nakai¹,

Niwa

Kitayama

et al. 2012

J Anesth

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Recent preanesthetic fasting practice allows patients to take clear fluids up to 2 h before surgery without taking any antacid for the prophylaxis of aspiration pneumonia; this practice is defined as oral rehydration therapy (ORT). It has been reported that with ORT the gastric volume may be significantly lower than that with a standard fasting regimen, although in a standard fasting regimen without preanesthetic antacid, gastric pH and volume values could be critical for causing aspiration pneumonia. In this study we compared gastric fluid status in patients with ORT and those with a standard fasting regimen; patients in both groups received a preanesthetic H(2) antagonist. One hundred and four patients were randomly assigned to either the ORT or standard fasting group, and all were given roxatidine 75 mg 2 h before surgery. After the induction of anesthesia, the gastric contents were collected via a gastric tube to measure gastric volume and pH. Neither gastric volume nor pH differed between the groups (ORT 9.6 ± 8.2 ml and 5.6 ± 1.7, respectively, vs. standard fasting 8.5 ± 6.8 ml and 5.5 ± 1.7, respectively). These data suggest that ORT may not reduce gastric volume in patients receiving a preanesthetic H(2) antagonist.

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Does long-term medication with a proton pump inhibitor induce a tolerance to H2 receptor antagonist?

Abstract: These data suggest that long-term PPI medication may not induce a tolerance to H2RAs.

Cited by 5 publications

References 20 publications

A marked increase in gastric fluid volume during cardiopulmonary bypass

A marked increase in gastric fluid volume during cardiopulmonary bypass

Gastrointestinal Disorders: A Focus on Acid‐Suppressive Agents

Effects of oral rehydration therapy on gastric volume and pH in patients with preanesthetic H2 antagonist

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