Proton Pump Inhibitors In Patients Research Articles

More Concern About Proton-Pump Inhibitors in Patients with Cirrhosis and Ascites

Several studies have suggested that proton-pump inhibitors (PPIs) are associated with excess risk for spontaneous bacterial peritonitis (SBP) in

“Skip the Drips”: An Initiative to Promote the Appropriate Use of Proton Pump Inhibitors in Patients With Upper Gastrointestinal Bleeding

“Skip the Drips”: An Initiative to Promote the Appropriate Use of Proton Pump Inhibitors in Patients With Upper Gastrointestinal Bleeding

Prolonged utilization of proton pump inhibitors in patients with ischemic and valvular heart disease is associated with surgical treatments, weight loss and aggravates anemia

BackgroundProton pump inhibitors (PPIs) are among the commonest drugs used nowadays. The aim of our study was to analyze prolonged utilization of proton pump inhibitors in medical therapy of patients with ischemic and valvular heart disease. Secondly, profile of utilization was scrutinized to patient characteristics and type of cardiovascular treatments. MethodsThe study included consecutive patients scheduled for cardiovascular rehabilitation 2–6months after index cardiovascular treatment. ResultsTwo hundred ninety-four patients (n=294/604; 48.7%) have been using proton pump inhibitor in their therapy after index cardiovascular treatment. Cardiovascular treatments were powerfully connected with utilization of PPIs; surgery 5.77 (95%-confidence intervals [CI]: 4.05–8.22; p<0.001) and PCI 0.15 (CI: 0.10–0.22; p<0.001). The odds for having proton pump inhibitor in their chronic therapy were increased for atrial fibrillation 1.87 (CI: 1.08–3.23; p=0.025) and decreased for obesity 0.65 (CI: 0.45–0.96; p=0.035); surviving myocardial infarction 0.49 (CI: 0.29–0.83; p=0.035). Multinomial logistic regression controlled for existence of chronic renal disease found no significant association of renal dysfunction and PPI therapy. The existence of anemia was significantly increased in patients taking PPIs than controls; 6.00 (CI: 3.85–9.33; p<0.001). The use of PPI was also associated with worsening of metabolic profile, in part due to decreased utilization of ACE-inhibitors and statins. PPI consumption correlated with age of patients (Rho=0.216; p<0.001). ConclusionsHigh proportion of cardiovascular, particularly surgical patients with ischemic and valvular heart disease utilized proton pump inhibitor in prolonged courses. Prolonged courses of PPIs were connected with existence and worsening of red blood count indexes, older age, lesser weight of patients and underutilization of cardioprotective drugs.

728 “Skip the Drips”: An Initiative to Promote the Appropriate Use of Proton Pump Inhibitors in Patients With Upper Gastrointestinal Bleeding

728 “Skip the Drips”: An Initiative to Promote the Appropriate Use of Proton Pump Inhibitors in Patients With Upper Gastrointestinal Bleeding

Is there a relationship between hypomagnesemia and proton-pump inhibitors in patients on chronic hemodialysis?

AimWe investigated the association among long-term proton-pump inhibitors (PPIs) use with serum magnesium (Mg) levels in chronic hemodialysis (HD) patients, as well as possible association among PPI use and increased risk of cardiovascular (CVD) morbidity in HD patients. MethodsOf 418 HD patients that were screened for inclusion, 136 were excluded due to incomplete medical data, duration of renal replacement therapy (RRT) for less than 12months, use of Mg-based-phosphate binders or other Mg-based medications or either to presence of chronic increased GI losses. Among 282 patients included in the study, 170 patients were on PPIs. ResultsSerum Mg levels were significantly lower among PPI users vs. non-users (0.94±0.2 vs. 1.03±0.2mmol/L; p<0.0001). The median duration of PPI use was 27±9.6months (range from 12 to 108) and it was not significantly associated with Mg levels (r=0.116; p=0.167). Additionally, residual renal function didn't show a significant correlation with Mg concentration (r=−0.102; p=NS) in both groups of patients. The use of PPIs was an independent and strong predictor of low Mg concentrations even in multivariate analysis (OR 3.05; 95% CI 1.2498–7.4594, p=0.01). On the other hand, the daily dose of PPIs was not associated with low Mg levels. PPI users had a higher rate of adverse CVD events during the 1 year of follow-up in comparison to non-PPI users but that difference wasn't statistically significant (17.6% vs. 10.7%; p=0.110). ConclusionWe have found a significant association between PPI use and lower serum Mg levels in chronic HD patients.

Взаимосвязь фенотипа окислительного метаболизма и клинической эффективности ингибиторов протонной помпы у больных гастроэзофагеальной рефлюксной болезнью

Aim. Research of the clinical efficacy of proton pump inhibitors in patients with gastroesophageal reflux disease (GERD) with various phenotypes of oxidative metabolism, detected using the marker drug aminophylline. Material and methods. 65 patients were included into the study. Oxidative metabolism phenotype was evaluated by the aminophylline half-elimination period (method of aminophylline salivary detection was used), and the phenotype groups were classified into «quick», «slow» and «very slow» metabolizers. Helicobacter pylori was diagnosed using the urease breath test. Clinical efficacy of the standard omeprazole dose (20 mg OD) was evaluated by relieving heartburn and pain syndrome. Results and discussion. The conducted research revealed that among 65 patients with GERD quick oxidation phenotype was detected in 32,3% of patients, and slow oxidation phenotype — in 49,2% of patients, while in 18,5% of patients very slow oxidation phenotype was detected. When evaluating the impact of treatment on GERD clinical signs, quicker relief of heartburn was noted in the subgroup of very slow metabolizers compared to quick metabolizers. When comparing quick and slow metabolizers, the frequency of Helicobacter pylori eradication was significantly lower in the subgroup of quick metabolizers as opposed to very slow ones. Conclusion. Assessment of the rate of drug oxidative metabolism in liver enables the individualization of omeprazole treatment in patients with GERD. Apparently, in quick oxidation phenotype it is necessary to increase the daily dose of omeprazole. Patients with GERD and slow oxidation phenotype should be expected to have significant short-term clinical effect of standard omeprazole doses. Eradication therapy with the standard doses of drugs was less effective both in clinical and economic terms in patients with GERD and quick oxidative metabolism phenotype, unlike slow and very slow metabolizers.

Randomized, Comparative Study of Standard Dose of Rabeprazole versus Omeprazole in Gerd/Heartburn Symptom Relief

Aim and objective: Gastro-esophageal reflux disease (GERD) is becoming increasingly common in Africa and indeed in Nigeria. Data on the efficacy of proton pump inhibitors in patients with GERD are scanty. In this study, we compared symptom relief rate after first dose treatment with Rabeprazole i.e. 20 mg versus omeprazole 20 mg in GERD/Heart burn patients. Materials and Methods: A total of 66 consenting consecutive patients attending the General Out- Patient Department (GOPD) Clinic of the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Nigeria presenting with symptoms of GERD/ heartburn were enrolled for the study. At enrolment, severity of symptom was graded on a five-point scale from none (0), mild (1), moderate (2), severe (3) and very severe (4). After enrolment, the patients were blindly randomized into two groups of 33 each which received either 20mg of Rabeprazole (Barole) stat; Rab- group or 20mg of Omeprazole stat; Ome- group. Symptom status was recorded in Case Report Form (CRF) at enrolment and 1hr 30 min after the treatment with stat dose of the proton pump inhibitor. Efficacy of proton pump inhibitor in symptom relief for GERD/heartburn was assessed by observing the degree of symptom relief after 1hr 30 minutes in each of treatment groups. Approval for the study was obtained from the Ethical and Research Committee of EKSUTH. Informed consent was equally obtained from each of the participants. Data obtained were analyzed using scale of comparison. Results: The mean age of the population studied was aged 33.98 ± 9.43 years (age range 18-50 years). 19 (28.8%) were males while 47 (71.2%) were females (M: F of 1:2.5). 25.8% of participants had regurgitation as a symptom in addition to heartburn while 40.9% had other GI symptoms. The mean symptom severity score at baseline were 2.33, 0.36 and 0.52 for heartburn, regurgitation and other symptoms respectively. Two of the Rabeprazole group who had ‘Very severe’ heartburn was after 1hr 30mins downgraded to 1(50%) ‘Mild’ and 1 (50%) ‘Moderate’ while only 1 participant with ‘very severe’ heartburn was downgraded to ‘severe’ heartburn, 1hr 30mins after Omeprazole.Ten in the Rabeprazole group who presented with ‘severe’ heartburn were downgraded 4(40%) to ‘moderate’ and 6 (60%) ‘Mild’ heartburn compare with Omeprazole group where 10 of the participants who had ‘severe’ heartburn were downgraded to 6(60%) and 4(40%) with ‘moderate’ and ‘mild’ heartburn respectively. One of the participants in Rabeprazole group who had ‘Severe’ regurgitation was downgraded to ‘Nil’ regurgitation, while none of the participants in Omeprazole group had ‘severe’ regurgitation. Two of the participants in Rabeprazole group had other symptoms of ‘moderate’ severity that were downgraded to ‘No symptoms’ compared with 5 participants in Omeprazole group with other symptoms with ‘moderate severity’ out of which 3(60%) and 2(40%) were downgraded to ‘mild’ and ‘No symptoms respectively’. Conclusion: Symptomatic relief is one of the primary goals in the management GERD. In this study Rabeprazole (Barole®) is more effective in downgrading the heartburn and other symptoms in GERD within 90 minutes of treatment compared to treatment with Omeprazole.

Proton pump inhibitors in patients with high output stomas and enterocutaneous fistulae. Do they really help? An audit of a specialty clinic practice

Proton pump inhibitors in patients with high output stomas and enterocutaneous fistulae. Do they really help? An audit of a specialty clinic practice

Mo1116 Clinical and Impedance-pH Patterns Predict Response to Proton Pump Inhibitors in Patients With Non-Cardiac Chest Pain

Mo1116 Clinical and Impedance-pH Patterns Predict Response to Proton Pump Inhibitors in Patients With Non-Cardiac Chest Pain

Changes in serum magnesium concentration after use of a proton pump inhibitor in patients undergoing percutaneous coronary intervention

BackgroundAlthough cross-sectional studies have suggested a relationship between proton pump inhibitor (PPI) use and hypomagnesemia, no large-scale cohort study has been conducted to date. Here, we examined the changes in serum magnesium levels in response to PPI use. We hypothesized that PPI use might change the serum magnesium concentration. MethodsOf the 2,892 patients hospitalized for percutaneous coronary intervention between January 2007 and May 2012, 1,076 patients with normal baseline (1.6–2.5mg/dL) and follow-up serum magnesium concentrations were enrolled. These patients were divided into two groups: the PPI group and the control group. ResultsThe mean follow-up period was 9.51±2.94 months. The incidence of hypomagnesemia (<1.6mg/dL) was 0.4% (3/834) in the PPI group and 0.4% (1/242) in the control group (P=0.904). The change in magnesium levels did not differ between the two groups, and this result was maintained in the analysis of covariance after adjusting for confounding factors (P=0.381). Moreover, magnesium levels did not significantly differ between the long-term (duration of use ≥12 months, n=71) and short-term PPI groups (duration of use <12 months, n=763), and the control group (n=242; P=0.620). The effect of PPI use on change in serum magnesium concentration was affected by the use of multiple diuretics (−0.01±0.25mg/dL; P=0.025), although a single diuretic use with PPI did not alter the change in magnesium level (0.12±0.27mg/dL). ConclusionChanges in magnesium levels might be subtle after PPI use in patients with normal baseline magnesium values.

Therapy with proton pump inhibitors in patients with type 2 diabetes is independently associated with improved glycometabolic control.

Experimental data demonstrated that gastrin has incretin-like stimulating actions on β-cells, resulting in a promotion of glucose-induced insulin secretion. As proton pump inhibitors (PPIs) consistently increase plasma gastrin levels, a possible effect of this treatment on glucose-insulin homeostasis may be hypothesized. Therefore, the aim of this study was to evaluate the effect of chronic PPIs treatment on glycemic control in patients affected by type 2 diabetes. This is an observational, retrospective study. A total of 548 consecutive patients with type 2 diabetes (mean age ± SD: 67.1 ± 10.9 years, M/F: 309/239, diabetes duration: 12.4 ± 9.8 years) referring to our diabetes outpatient clinics were enrolled; among them, 45 %were treated with PPIs longer than 2 years for preventive/therapeutic purposes. Fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), serum lipids and transaminases were measured by standard laboratory methods. Major cardiovascular events and concomitant medications were recorded in all participants, and daily insulin requirement was calculated in insulin-treated subjects. PPIs-treated patients had significantly lower HbA1c (7.1 ± 1.07 %-54.1 ± 12 vs 7.4 ± 1.4 %-57.4 ± 8 mmol/mol, p = 0.011) and FPG (127 ± 36.9 vs 147.6 ± 49.4 mg/dl, p < 0.001) levels than those untreated. These differences increased in patients under insulin therapy and in those with concomitant PPIs + GLP-1-based therapy. The multivariate regression analysis demonstrated that the association between chronic PPIs treatment and HbA1c was independent from possible confounders (p = 0.01). PPIs treatment is associated with greater glycemic control in patients with type 2 diabetes, particularly in those on insulin- or GLP-1-based therapy. Our results suggest a role for PPIs in glucose-insulin homeostasis and may open a new scenario for diabetes therapy.

Применение ингибиторов протонной помпы у пациентов с гастроэзофагеальной рефлюксной болезнью на фоне ишемической болезни сердца

Применение ингибиторов протонной помпы у пациентов с гастроэзофагеальной рефлюксной болезнью на фоне ишемической болезни сердца

Correction

Correction

Tu1876 Factors Associated With Non Response to Proton Pump Inhibitors in Patients Referred for Esophageal pH-Impedance Monitoring

Background: Esophageal epithelial integrity is considered an important factor in the prevention of tissue damage by gastric refluxate.We hypothesized that in patients with gastroesophageal reflux disease (GERD) the esophageal epithelial barrier function is impaired and less resistant in response to acid exposure. We therefore investigated esophageal epithelial integrity in GERD patients and in healthy controls both in the basal state and in response to acid exposure Methods: 14 patients with chronic GERD (8 with erosive esophagitis, 6 with non-erosive reflux disease) and 10 healthy controls (HC) were enrolled. Before endoscopy, GERD patients discontinued PPI therapy for 7 days. Six esophageal biopsies frommacroscopically normal mucosa were obtained approximately 5 cm above the gastroesophageal junction and directly transferred to a mini-Ussing chamber system. After an equilibration period, baseline TEER was assessed. Half of the biopsies were then exposed at their luminal side to an acidic solution (pH1) for 30 minutes. During exposure and after removal of the acidic solution, changes in TEER were analyzed relative to baseline TEER. Permeation to the paracellular permeation marker fluorescein (375 DA 1 mg/ml) was assessed in all biopsies (previous acid-exposed and non-exposed) for 120 minutes. Only subjects with at least two adequate biopsies (one for acid exposure, one as a control) were included. Results: Esophageal epithelium of GERD patients showed lower baseline TEER (127.7±13.3 Ω vs. 174.3±17.6 Ω, p=0.04) and a trend toward higher transmucosal permeation of fluorescein in the nonexposed biopsies when compared to healthy controls (serosal concentration (pmol/ml) after 120 min: 48.2 (7.6-66.7) vs. 6.8 (3.6-20.2), p=0.09 and AUC: 79.8 (12.9-135.6) vs. 9.0 (5.5-31.3), p=0.07). Acid exposure provoked a fall in TEER that was equal for the biopsies of GERD patients and healthy controls (-52.1±2.5% vs. -50.0±4.4% of baseline TEER). After removal of the acidic solution, TEER recovered also to a similar extent in GERD patients and healthy controls (89.6±3.8% vs. 93.8±3.0% of baseline TEER). However, maximum TEER was reached earlier in biopsies of GERD patients (54±9 min vs. 83±6 min (HC), p= 0.02) and at the end of the experiment, TEER relative to baseline was lower in biopsies of GERD patients (73.7±5.8% vs. 89.7±3.3% (HC) of baseline TEER, p<0.05). Conclusion: The esophageal epithelial barrier function of GERD patients is impaired, reflected by lower baseline transepithelial electrical resistance and a trend toward higher fluorescein permeation, and seems to be less resistant in response to acid exposure ex-vivo.

TCTAP A-029 Low Dose Proton Pump Inhibitors in Patients Treated with Dual-antiplatelet Therapy After Acute Coronary Syndrome

TCTAP A-029 Low Dose Proton Pump Inhibitors in Patients Treated with Dual-antiplatelet Therapy After Acute Coronary Syndrome

Letter: Epstein–Barr virus status may be especially important in paediatric IBD populations

Remission in proton pump inhibitor-responsive esophageal eosinophilia correlates with down regulation of eotaxin-3 and TH2 cytokines, similarly to eosinophilic esophagitis after steroids. Gastroenterology 2013; 144(Suppl. 1): S-484. 7. Dranove JE, Horn DS, Davis MA, et al. Predictors of response to proton pump inhibitor therapy among children with significant esophageal eosinophilia. J Pediatr 2009; 154: 96–100. 8. Sayej WN, Patel R, Baker RD, et al. Treatment with high-dose proton pump inhibitors helps distinguish eosinophilic esophagitis from noneosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2009; 49: 393–9. 9. Peterson KA, Thomas KL, Hilden K, et al. Comparison of esomeprazole to aerosolized, swallowed fluticasone for eosinophilic esophagitis. Dig Dis Sci 2010; 55: 1313–9. 10. Abe Y, Iijima K, Ohara S, et al. A Japanese case series of 12 patients with esophageal eosinophilia. J Gastroenterol 2011; 46: 25–30. 11. Francis DL, Foxx-Orenstein A, Arora AS, et al. Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis. Aliment Pharmacol Ther 2012; 35: 300–7. 12. Schroeder S, Capocelli KE, Masterson JC, et al. Effect of proton pump inhibitor on esophageal eosinophilia. J Pediatr Gastroenterol Nutr 2013; 56: 166–72. 13. Fujiwara Y, Sugawa T, Tanaka F, et al. A multicenter study on the prevalence of eosinophilic esophagitis and PPI-responsive esophageal eosinophilic infiltration. Intern Med 2012; 51: 3235–9. 14. Moawad FJ, Schoepfer A, Ally MR, et al. Eosinophilic esophagitis and proton pump inhibitor responsive esophageal eosinophilia: are they one and the same? Gastroenterology 2013; 144(Suppl. 1): S489 (Su1845). 15. Mangla S, Singal G, Hornick JL, et al. Clinical predictors of response to proton pump inhibitors in patients with esophageal eosinophilia. Gastroenterology 2013; 144(Suppl. 1): S495–6 (Su1866). 16. Dellon ES, Speck O, Woodward K, et al. Clinical and endoscopic characteristics do not reliably differentiate PPIresponsive esophageal eosinophilia and eosinophilic esophagitis in patients undergoing upper endoscopy: a prospective cohort study. Am J Gastroenterol 2013; doi: 10.1038/ajg.2013.363 [Epub ahead of print].

Influence of Age on Treatment with Proton Pump Inhibitor in Patients with Laryngopharyngeal Reflux Disease

Objectives: The influence of age in severity and response to proton pump inhibitor (PPI) in patients with laryngopharyngeal reflux (LPR) is unclear. Thus, we conducted a prospective cohort study to assess the difference in severity and response to PPI according to age in patients with LPR. Methods: Two hundred twenty-nine patients with LPR who were referred to the otolaryngology clinic from November 2010 to February 2012 were enrolled in the study. All of the enrolled patients were prescribed 15mg of Lansoprazole (PPI) twice daily for three months. Data, including the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), and LPR-Health related quality of life (LPR-HRQOL), were collected from patients at the baseline visit and at 1 and 3 months post-baseline. Results: The older patients group (60-79 years) showed a higher score in RSI ( P &lt; 0.001) and LPR-HRQOL (p&lt;0.001) at baseline than the younger subgroups. However, the RFS score showed no significant difference among age subgroups. Within each age subgroup, RSI, RFS, and LPR-HRQOL showed significant improvement with PPI therapy; however, no difference in improvement of RSI, RFS, or LPR-HRQOL was seen among the subgroups. The responders who had changes in RSI score at three months were found significantly more often in the younger group than the older group ( P = 0.002). Conclusions: Age appears to affect the subjective symptoms and resulting impact on their QOL but not laryngeal finding in patients with LPR. Furthermore, the clinician should be aware that older patients are more likely to not respond to PPI.

Meta-analysis: comparison of oral vs. intravenous proton pump inhibitors in patients with peptic ulcer bleeding

The efficacy of adjuvant use of intravenous proton pump inhibitors (PPIs) after endoscopic therapy has been proved in peptic ulcer bleeding patients, but the efficacy of oral PPIs is uncertain. To compare the clinical outcomes of oral PPIs vs. intravenous PPIs in patients with peptic ulcer bleeding. Prospective randomised controlled trials were systematically searched from OVID databases until June 2012. Trials comparing oral and intravenous PPIs among patients with peptic ulcer bleeding were included. Recurrent bleeding, length of hospitalisation, blood transfusion, requirement of surgery and mortality were measured. The risk of bias, study quality and heterogeneity were also evaluated. Six randomised trials from 2006 to 2011 were included. A total of 615 patients were randomly assigned to receive oral PPIs (n = 302) or intravenous PPIs (n = 313). The mean age was 60 years and 71.1% was male. No significant difference between oral and intravenous PPIs was observed regarding recurrent bleeding (RR: 0.92, 95% CI: 0.56-1.50), mean volume of blood transfused (-0.02 unit, 95% CI: -0.29-0.24 unit), requirement of surgery (RR: 0.82, 95% CI: 0.19-3.61) and all-cause mortality (RR: 0.88, 95% CI: 0.29-2.71). The duration of hospital stay in days was significantly shortened in those using oral PPIs (-0.74 day, 95% CI: -1.10 day to -0.39 day). Oral PPIs demonstrate a similar effectiveness to intravenous PPIs among patients with peptic ulcer bleeding, but the results were combined from open-labelled trials with limited sample size. A large double-blind non-inferiority trial is required to better assess the role of oral PPIs.

GW24-e2973 Safety of clopidogrel and proton pump inhibitors in patients undergoing percutaneous coronary intervention; A meta-analysis

ObjectivesTo perform a meta-analysis in order to determine safety of concomitant use of clopidogrel and proton pump inhibitors (PPIs) in patients undergoing percutaneous coronary intervention (PCI).MethodsReferences (including original papers, conference...

Su1866 Clinical Predictors of Response to Proton Pump Inhibitors in Patients With Esophageal Eosinophilia

Su1866 Clinical Predictors of Response to Proton Pump Inhibitors in Patients With Esophageal Eosinophilia