Double Doses Of Proton Pump Inhibitors Research Articles

Современные подходы к инициальному и противорецидивному лечению гастроэзофагеальной рефлюксной болезни

В статье рассмотрены современные подходы к инициальному и противорецидивному лечению гастроэзофагеальной рефлюксной болезни (ГЭРБ), основанные на рекомендациях двух последних американских консенсусов. Согласно этим данным, основными препаратами для лечения ГЭРБ являются ингибиторы протонной помпы (ИПП), которые условно делятся на препараты I и II поколения и могут применяться как в стандартных, так и в двойных и половинных дозах. Препараты II поколения являются более эффективными и безопасными, поскольку меньше зависят от полиморфизма CYP2C19. Сделан вывод, что в большинстве случаев инициальное лечение должно начинаться с применения стандартных или двойных доз ИПП, а поддерживающее — в стандартных или половинных дозах, применяемых по разным схемам — постоянной, интермиттирующей или терапии «по требованию». Наилучшим препаратом для длительного лечения ГЭРБ, особенно при необходимости приема других препаратов, является пантопразол.

Evidence-based treatments for eosinophilic esophagitis: insights for the clinician.

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. Left untreated, EoE progresses to fibrous remodeling and stricture formation that impairs quality of life. Therefore, EoE requires either repeated treatments or maintenance therapy. Current guidelines recommend swallowed topical corticosteroids (STCs), proton-pump inhibitors (PPIs), or dietary intervention as initial options to induce and maintain long-term disease remission. Impractical exclusive elemental diets and suboptimal allergy testing-directed food avoidance paved the way for empirical elimination diets. These are moderately effective and highly reproducible in inducing EoE remission and allow for identification of specific food triggers. Step-up strategies, including two- and four-food rather than six-food elimination diets, should be considered as initial approaches for dietary treatment in patients of all ages, as they reduce the need for endoscopic procedures, shorten diagnostic processing time, and avoid unnecessary restrictions. Formulations of STC originally designed for asthma therapy are suboptimal for EoE treatment, with new effervescent orodispersible tablets and viscose formulations designed to coat the esophageal mucosa providing increased effectiveness at reduced doses. The anti-inflammatory effects of PPI in EoE are independent from gastric acid secretion inhibition; despite evidence from observational research, PPIs are the most commonly prescribed first-line therapy for EoE due to their accessibility, low cost, and safety profile. Double doses of PPI only induce remission in half of EoE patients, irrespective of the drug used or patients’ age. Inflammatory rather than stricturing EoE phenotype and treatment duration up to 12 weeks increase chances of achieving EoE remission. Most responders effectively maintain long-term remission with standard PPI doses. Finally, endoscopic dilation should be considered in patients with reduced esophageal caliber or persistent dysphagia despite histological remission. This article provides a state-of-the-art review and updated discussion of current therapies and newly developed options for EoE.

Features of management of patientswith NSAID-induced gastropathy: from understanding the mechanisms of development to the strategy of prevention and treatment. Risks of short-term use of non-steroidal anti-inflammatory drugs. Part I

Nonsteroidal anti‑inflammatory drugs (NSAIDs) is a big group of medications with different chemical structure but common mechanisms of pharmacological actions and ability to provide analgesic, anti‑inflammatory and antipyretic effects. NSAIDs is one of the therapeutically instruments to relief acute and chronic pain at a wide spectrum of diseases and pathological conditions. NSAIDs administration is an integral part of the work of physicians, rheumatologists, neurologists, anesthesiologists, surgeons, traumatologists, gynecologists and other medical specialties. NSAIDs are effective and easy to use, but they can cause serious complications and first of all, the gastrointestinal adverse events.The paper present analysis of the structure of drug‑induced injuries of upper gastrointestinal tract in patients taking NSAIDs. The risks of adverse events that develop against the background of short‑term NSAIDs use for analgesic, anti‑inflammatory, antipyretic purposes have been discussed. The data on the frequency and features of clinical, endoscopic and morphological manifestations of NSAID‑gastropathies are presented. The danger of these complications, which may be accompanied by life‑threatening conditions such as bleeding or perforation, has been demonstrated. The role of modern endoscopic methods for the diagnosis of NSAID‑gastropathies is evaluated. Based on a clinical example, the authors proposed a strategy for the prevention and treatment of NSAID‑gastropathy, which arose against the background of asymptomatic Helicobacter pylori infection. Current data on various strategies for the treatment and prevention of NSAID gastropathies are presented. Based on the analysis, it has been concluded that the use of proton pump inhibitors (PPIs) and the eradication of Helicobacter pylori infection are the best strategies. The use of double doses of PPIs makes it possible to increase the effectiveness of prevention and treatment of NSAID‑gastropathies, as well as eradication therapy.

Low-dose amitriptyline combined with proton pump inhibitor for functional chest pain

To investigate the efficacy of amitriptyline with proton pump inhibitor (PPI) for the treatment of functional chest pain (FCP). This was a randomized, open-label trial investigating the addition of low dose amitriptyline (10 mg at bedtime) to a conventional dose of rabeprazole (20 mg/d) (group A, n = 20) vs a double-dose of rabeprazole (20 mg twice daily) (group B, n = 20) for patients with FCP whose symptoms were refractory to PPI. The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with > 50% improvement in their symptom score. The between-group difference in global symptom scores was statistically significant during the last week of treatment (overall mean difference; 3.75 ± 0.31 vs 4.35 ± 0.29, the between-group difference; P < 0.001). Furthermore, 70.6% of patients in group A had their symptoms improve by > 50%, whereas only 26.3% of patients in group B had a similar treatment response (70.6% vs 26.3%, P = 0.008). Specifically, patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B (52.37 ± 17.00 vs 41.32 ± 12.34, P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84, P = 0.01, respectively). Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.

Acid and non-acid reflux in Japanese patients with non-erosive reflux disease with persistent reflux symptoms, despite taking a double-dose of proton pump inhibitor: a study using combined pH-impedance monitoring

Combined multi-channel intra-luminal impedance and pH (Mll-pH) monitoring can detect gastro-esophageal reflux and identify acid and non-acid reflux (NAR) events. It can be used for patients with persistent symptoms who are having proton pump inhibitor (PPI) therapy. The aim of this study is to determine the frequency of acid reflux and NAR and to establish their relationship with persistent reflux symptoms in Japanese patients with non-erosive reflux disease (NERD) who are on a double-dose of PPI therapy. Thirteen patients with NERD, with persistent reflux symptoms, despite taking PPI at least twice daily, were included in this study. Twenty-four-hour combined Mll-pH monitoring was carried out on all patients and reflux episodes were detected by impedance channels, located at 3, 5, 7, 9, 15 and 17 cm above the lower esophageal sphincter (LES) and classified into acid reflux and NAR, based on pH data from 5 cm above the LES. A positive symptom index (SI) was declared, if at least half of the symptoms were preceded by reflux episodes within 5 min. A total of 916 liquid reflux episodes were detected, and a total of 171 symptoms were recorded. Eight (4.7%) of 171 symptoms were related to acid reflux, and 68 (39.8%) were related to NAR. Seven (53.8%) patients had a positive SI and in these seven patients, a total of 79 symptoms were recorded. 5 (6.3%) of the 79 symptoms were related to acid reflux and 44 (55.7%) were related to NAR. Persistent reflux symptoms, in SI-positive patients with NERD on double-dose PPI therapy, are more likely to be associated with primarily non-acid reflux.