Overuse of proton pump inhibitors

Ksiądzyna, Dorota; Szeląg, Adam; Paradowski, Leszek

doi:10.20452/pamw.2790

Cited by 30 publications

(33 citation statements)

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“…The current medical treatment for peptic ulcers is generally based on proton pump inhibitors and histamine H 2 -receptor blockers (Jain et al, 2007). However, the long-term use of these therapeutic agents can produce adverse effects, such as hypergastrinemia and hyperplasia in the enterochromaffinlike (ECL) cells, the risk of pneumonia, diarrhea and the disturbance of human gastrointestinal microflora (Orlando, Lenard, Orlando, 2007;Bays, Finch, 1990;Devault, Talley, 2009;Ksiadzyna, Szelag, Paradowski, 2015). Therefore, the search for safer and more effective alternatives to treat F. Sobreira, L. S. Hernandes, A. Vetore-Neto, I. E. C. Díaz, F. C. Santana, J. Mancini-Filho, E. M. Bacchi Braz.…”

Section: Introductionmentioning

confidence: 99%

Gastroprotective activity of the hydroethanolic extract and ethyl acetate fraction from Kalanchoe pinnata (Lam.) Pers.

Sobreira

Hernandes

Vetore-Neto

et al. 2017

Braz. J. Pharm. Sci.

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Peptic ulcers are an important pathology, and the search for safer and more effective treatment methods is of paramount importance. In this study, we assess the gastroprotective effects of the hydroethanolic extract (HE) and ethyl acetate fraction (EAF) from Kalanchoe pinnata leaves against an ethanol/HCl-induced ulcer model in rats. The HE reduced gastric lesions by approximately 47% (400 mg/kg). A significant inhibition of the gastric lesions by 50% was observed after pretreatment with the EAF (200 mg/kg). Quercetrin and quercetin 3-O-α-L-arabinopyranosyl-(1→2)-α-L-rhamnopyranoside were isolated and identified in the flavonoid fraction (EAF) by HPLC and NMR analyses because this fraction showed the highest gastroprotective effect. This fraction demonstrated high antioxidant activities (CE 50 =41.91 µg/mL) by DPPH in comparison with Trolox ® and 11.33 mmol Trolox ® equivalent by ORAC. In conclusion, the HE and FAE from K. pinnata displayed gastroprotective activity in rats, most likely due to the presence of flavonoids.Uniterms: Gastric ulcer/study/rats. Gastric ulcer/treatment. Kalanchoe pinnata/chromatographic profile. Kalanchoe pinnata/gastroprotective activity. Quercetrin. Quercetin 3-O-α-L-arabinopyranosyl-(1→2)-α-L-rhamnopyranoside. INTRODUCTIONFor the past two centuries, peptic ulcers have caused high morbidity and mortality (Malfertheiner, Chan, Mccoll, 2009). This disease is a serious and prevalent pathology (Calam, Baron, 2001). A peptic ulcer is a chronic lesion, usually single, that can be located in the gastric or duodenal mucosae (Kumar, Abbas, Fausto, 2005). In the UK, the incidence of this disease was 12% higher in men than in women (Araujo, Borini, Guimarães, 2014). A review article (January 1980 to February 2009 showed that the incidence rate of uncomplicated peptic ulcers was approximately one case per 1000 people per year in the general population; the incidence rate for complicated peptic ulcers that included bleeding and perforation was approximately 0.7 cases per 1000 people per year (Lin, Rodrígues, Hernándes-Diaz, 2011).The pathophysiology of peptic ulcers suggests that this disease is caused by an imbalance between defensive factors (mucus and bicarbonate secretion, mucosal barrier, blood flow, and prostaglandins) and destructive factors (reactive oxygen species and acid and pepsin secretion), resulting in the acute inflammation of the gastrointestinal mucosae (Laine, Takeuchi, Tarnawski, 2008). Several stimuli serve as offensive factors, including Helicobacter pylori, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), stress, alcohol and cigarette smoking (Malfertheiner, Chan, Mccoll, 2009;Malnick et al., 2014). The current medical treatment for peptic ulcers is generally based on proton pump inhibitors and histamine H 2 -receptor blockers (Jain et al., 2007). However, the long-term use of these therapeutic agents can produce adverse effects, such as hypergastrinemia and hyperplasia in the enterochromaffinlike (ECL) cells, the risk of pneumonia, diarrhea and the disturbance of ...

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Section: Introductionmentioning

confidence: 99%

Gastroprotective activity of the hydroethanolic extract and ethyl acetate fraction from Kalanchoe pinnata (Lam.) Pers.

Sobreira

Hernandes

Vetore-Neto

et al. 2017

Braz. J. Pharm. Sci.

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“…The overuse of PPIs has been demonstrated in several studies (10)(11)(12). In a study conducted at the Hospital de Guadalajara, Martín-Echevarría et al found that among patients taking PPIs at admission, 73% had an inadequate indication and 38% of patients were discharged with this medication even without correct indication (13).…”

Section: Overuse and Its Consequencesmentioning

confidence: 99%

“…The absorption of vitamin B 12 and magnesium requires gastric acid and PPIs could be responsible for producing deficiencies of these elements. In the case of vitamin B 12 , most of the studies are case-control and many of them have been questioned because the method of measurement of vitamin B 12 is not taking into account the patient's diet (29,30).…”

Section: Overuse and Its Consequencesmentioning

confidence: 99%

“…In the case of vitamin B 12 , most of the studies are case-control and many of them have been questioned because the method of measurement of vitamin B 12 is not taking into account the patient's diet (29,30). Furthermore, studies of low methodological consistency have associated PPI for over a year with hypomagnesaemia (31,32).…”

Section: Overuse and Its Consequencesmentioning

confidence: 99%

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Practical considerations in the management of proton-pump inhibitors

Aguilera¹,

Martín-de-Argila-dePrados²,

Albillos-Martínez³

2015

Rev Esp Enferm Dig

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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 ...

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“…In this regard, several reports have suggested that PPIs are being overused in hospital and ambulatory care settings [10,15,16], and that the appropriateness of PPIs prescriptions in some hospitals may be as low as 8.3 % [16]. Suggested causes contributing to the inappropriate overuse of PPIs include physician type, practice setting, formulary status and consumer-oriented advertising [17].…”

Section: Introductionmentioning

confidence: 99%