Role Of Proton Pump Inhibitors Research Articles

Drug Induced Rowell’s Syndrome: A Rare Presentation

Rowell’s syndrome (RS) is a rare disorder characterized by Erythema multiforme (EM)-like lesions in a patient with lupus erythematosus, either systemic lupus erythematosus (SLE) or cutaneous lupus erythematosus (CLE). A 35 years old female presented in our dermatology outpatient department (OPD) with complaint of hemorrhagic crusting of lips and multiple discrete targetoid lesions over the chest, upper limb, and gluteal region. Investigations revealed a speckled pattern of antinuclear antibody (ANA), anti-Smith antibody, anti-ds DNA antibody, and strongly positive anti-Ro antibody. According to the clinical evaluation and investigations, the diagnosis of drug induced RS was made. The likely role of proton pump inhibitors, namely esomeprazole as a triggering factor is discussed. After stopping esomeprazole and starting medications with oral steroids and hydroxychloroquine, her good response to treatment was noted.

The Role of Proton Pump Inhibitors in the Realm of Idiopathic Pulmonary Fibrosis and its Associated Comorbidities: A Systematic Review.

As the global incidence of idiopathic pulmonary fibrosis (IPF) is on the rise, there is a need for better diagnostic criteria, better treatment options, early and appropriate diagnosis, adequate care, and a multidisciplinary approach to the management ofpatients. This systematic review explores the role of proton pump inhibitors (PPIs) in IPF and answers the question, "Does proton pump inhibitor improve only the prognosis of gastroesophageal associated idiopathic pulmonary fibrosis or for other types of idiopathic pulmonary fibrosis too?" We used PubMed (PMC) and Google Scholar for data collection for this systematic review and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting this review. After in-depth literature screening and quality appraisal, 12 articles were selected for this systematic review. On the one hand, the efficacy of PPI therapy is supported by research such as the CAPACITYand ASCEND trials, a pilot randomized control trial (RCT) investigating the role of omeprazole in IPF and a bidirectional two-sample Mendelian randomization (MR) study, respectively. On the other hand, a systematic reviewand meta-analysison antacid and antireflux surgery in IPFnegate these results and show no statistical significance. Questions regarding the efficacy of PPI therapy must be dealt with in an adequately powered multicenter and double-blinded randomized control trial. The anti-inflammatory properties of antacids can serve as the cornerstone for future trials. In the following systematic review, antacid, antireflux therapy, omeprazole, and proton pump therapy are synonymous with stomach acid suppression therapy.

Role of proton pump inhibitors in immune checkpoint inhibitor colitis.

743 Background: Proton pump inhibitors (PPIs) are known to be beneficial in symptomatic control of gastroesophageal reflux disease and gastritis which can be a common complication of various cancers specifically gastrointestinal (GI) cancers. Microscopic colitis development has been studied to be associated with PPI use. Immune checkpoint Inhibitor (ICI) colitis is a known adverse effect of Inhibitors of Programmed cell death 1 (PD-1) and its ligand (PD-L1). Previous studies have also shown use of PPIs and NSAIDs are common risk factors which can exacerbate ICI Colitis caused by Inhibitors of PD-1 and PD-L1. This study is designed to observe association of certain drugs especially PPIs in ICI colitis. Methods: This is a single center, retrospective, and observational study that investigated patients treated with PD-1 and PD-L1 Inhibitors for management of any type of cancer between January 2022- September 2023. A list of patients treated with PD-1 and PD-L1 inhibitors was obtained from Inpatient pharmacy records followed by retrospective chart review to look for symptoms of colitis and other medications used by each patient. Primary outcome was to observe the role of PPIs in ICI colitis. Secondary outcomes were to observe the number of patients with GI cancers on PPIs who developed colitis. We also observed the effect of NSAIDs use as a potential risk factor in the population with ICI colitis. Results: The data consisted of 93 patients of which 17 (18.3%) developed colitis. Among this population 13 (76.5%) was ICI colitis, 2 (11.7%) was diverticular colitis and 2 (11.7%) was Infectious colitis. PPI use was seen in 3 out of 13 patients (23%) with ICI colitis. Patients with any type of GI cancer who developed colitis was 5 (25%) and PPI use in ICI colitis was seen in 2 out of these 5 patients. NSAIDs use was seen in 3 (23%) patients with ICI colitis. Conclusions: We did not observe significant association between PPI use and ICI colitis. ICI use becoming increasingly common in oncologic population, larger studies may be needed to further evaluate risk factors associated with ICI colitis in this population.

Role of Proton Pump Inhibitors in the Management of Peptic Ulcer

Proton pump inhibitors (PPIs) have been used to treat a variety of conditions affecting the upper gastrointestinal tract including gastroesophageal reflux disease (GERD), esophagitis, Zollinger-Ellison syndrome (ZES) and dyspepsia. PPIs are also useful in the treatment of Helicobacter pylori infection as well as the prevention of upper gastrointestinal tract ulcers and bleeding in patients who are taking non-steroidal anti-inflammatory drugs (NSAIDs). It is critical to get the best clinical response possible for people with an upper gastrointestinal peptic disorder. This is dependent on the PPI used. Although all members of this class suppress active parietal cell acid secretion in the same way, there are minor variations in pharmacokinetic characteristics, metabolism and FDA-approved therapeutic indications among PPIs. Regardless of this, each is successful in treating GERD and peptic ulcers. Despite their overall effectiveness, PPIs have certain drawbacks, including short plasma half-lives and the need for meal-associated dosing, which can cause breakthrough symptoms in some people, particularly at night. This article discusses the current indications for PPIs in the treatment of peptic ulcers, as well as their pharmacokinetics and pharmacodynamics.

Molecular Insights into the Mechanism of Modulatory Effects of Proton Pump Inhibitors on P-glycoprotein Mediated Drug Transport of Palbociclib and Ribociclib.

Palbociclib and ribociclib are substrates of efflux transporter, P-glycoprotein plays a key role in absorption and transport of these drugs. Proton pump inhibitors, when co-administered with them are known to show inhibitory effect on P-glycoprotein. Therefore, this study aims to investigate the role of proton pump inhibitors in inhibition of P-glycoprotein mediated efflux of palbociclib and ribociclib. A combined approach of molecular docking and ex vivo everted gut sac model was implemented to predict the potential of proton pump inhibitors i.e., omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole to inhibit the P-glycoprotein mediated intestinal transport of palbociclib and ribociclib and study the molecular basis of interaction taking place. Molecular docking studies revealed that omeprazole, rabeprazole and pantoprazole bound to the ATP site of nucleotide binding domain with binding energies of -27.53, -29.56 and -38.44 Kcal/mol respectively. In ex-vivo studies, rabeprazole and omeprazole, affected the absorptive permeability of palbociclib by 3.04 and 1.26 and ribociclib by 1.76 and 2.54 folds, respectively. Results of molecular docking studies and ex vivo studies highlighted that proton pump inhibitors bound to the ATP binding site to block its hydrolysis thereby inhibiting the P-glycoprotein mediated efflux of palbociclib and ribociclib. The experimental evidence presented highlights the fact that proton pump inhibitors have potential to inhibit P-glycoprotein, giving rise to drug interactions with palbociclib and ribociclib. Hence, monitoring is required while proton pump inhibitors and cyclin-dependent kinase inhibitors are being co-administered to avoid adverse events.

Low prevalence of positive hydrogen breath tests in patients with functional gastrointestinal conditions and hypermobile Ehlers-Danlos syndrome.

Using hydrogen breath testing (HBT) to diagnose small intestinal bacterial overgrowth (SIBO) remains controversial in patients with functional gastrointestinal (GI) disorders, and unknown in those with hypermobility Ehlers-Danlos syndrome (hEDS). We assessed prevalence of positive HBTs in these groups, evaluated the predictive value of GI symptoms and the potential role of proton pump inhibitors (PPIs) on test results. Sequential patients referred for HBT to a tertiary unit were classified into the following groups: GI maldigestion/malabsorption, GI sensorimotor disorders, hEDS, and functional GI disorders. All underwent standardized HBT, and the yield was assessed against symptoms and PPI use. A total of 1062 HBTs were performed over 3 years (70% female, mean age 48 ± 16 years). Overall, 7.5% (80/1062) patients had a positive HBT. Prevalence of positive HBT was highest in patients with GI maldigestion/malabsorption (17.9%; DOR 16.16, p < 0.001), GI sensorimotor disorders (15.9%; DOR 8.84, p < 0.001), compared to functional GI disorders (1.6%; DOR 1.0) (p < 0.0001). None of the hEDS patients tested positive for HBT. A positive HBT was independently associated with increased age (DOR 1.03; p < 0.001) and symptoms of diarrhea (DOR 3.95; p < 0.0001). Patients on PPIs tended towards a positive HBT than patients off PPIs (16.1% vs 6.9%; DOR 2.47; p < 0.0001). Less than 2% of patients with functional GI disorders, and none of the patients with hEDS had a positive HBT. Pre-test probability was higher in patients with: GI structural or neurological disorders; use of long-term PPIs and symptoms of diarrhea. These criteria may be helpful in making appropriate therapeutic decisions and avoiding unnecessary hydrogen breath testing.

High vs Low Dose Proton Pump Inhibitor (PPI) related Mortality in Hospitalized Coronavirus Disease-19 (COVID-19): A Retrospective Cohort Study

Introduction: The role of proton pump inhibitor (PPI) in Coronavirus Disease-19 (COVID-19) is still debatable. PPI is commonly used to prevent or treat upper gastrointestinal bleeding and/or dyspeptic symptoms. However, previous studies showed that PPI may lead to adverse outcomes in COVID-19 patients, thus the dose of PPI may play an important role. This study aimed to compare the risk of mortality between high vs low dose PPI in hospitalized COVID-19 patients.&#x0D; Methods: We performed retrospective cohort study from two COVID-19 referral centers in Jakarta between June 2021 and September 2021. We included hospitalized COVID-19 patients, moderate-critically ill cases, who had been given intravenous PPI for more than 7 days. We defined high dose PPI for omeprazole &gt;40 mg/day or pantoprazole &gt;40 mg/day, and low dose PPI for omeprazole ≤40 mg/day or pantoprazole ≤40 mg/day.&#x0D; Results: Of the total 365 patients (median age[Q1–Q3] 55 [45–64] years old), 216 subjects were given high dose PPI. Subjects with high dose PPI had a significantly higher mortality rate than the low dose PPI according to bivariate analysis (54.2% vs 26.1%; p&lt;0.001), but quite similar length of stay (median[Q1–Q3] 12.5 [9–16] vs 13 [9–18] days). After conducting a multivariate analysis to control the confounders, we found that high dose PPI still led to higher mortality (aOR 3.04; 95%CI 1.22–7.60; p=0.017).&#x0D; Conclusion: High dose PPI may increase risk of mortality in hospitalized COVID-19 patients.

Role of proton pump inhibitor in healing after choanal atresia repair: a randomized control trial

BackgroundChoanal atresia (CA), defined as the anatomical closure of the choanae in the nasal cavity, is relatively uncommon disease entity with an estimated incidence of 1:5000–7000 births. Post-operative restenosis remains a common complication of the endoscopic CA repair. Risk factors for restenosis include nasopharyngeal reflux and gastroesophageal reflux.ResultsForty patients who underwent choanal atresia repair were divided randomly into 2 groups. Group A patients received postoperative PPI medication compared to group B patients who acted as control who underwent the same operation without receiving postoperative proton pump inhibitor medication.Only 2 patients (10%) in group A experienced restenosis compared to 8 patients (40%) in the control group B.ConclusionThe use of esomeprazole which is a proton pump inhibitor acting as an antireflux should be considered, in postoperative treatment, to decrease the rate of choanal restenosis by preventing inflammation on choanal mucosa which can enhance good healing mechanism.

The role of Proton Pump Inhibitors in COVID-19

The role of Proton Pump Inhibitors in COVID-19

Proton Pump Inhibitor Therapy for Eosinophilic Esophagitis: History, Mechanisms, Efficacy, and Future Directions.

Over the past decade, the role of proton pump inhibitor (PPI) medication has evolved from a diagnostic tool for Eosinophilic Esophagitis (EoE), by excluding patients with PPI responsive esophageal eosinophilia (PPI-REE), to a therapy for EoE. This transition resulted from the Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the Appraisal of Guidelines for Research and Evaluation II (AGREE) Conference to support PPI therapy for EoE in children and adults. Additional recent advances have suggested a role for genetic variations that might impact response to PPI therapy for EoE. This review article will explore a brief background of EoE, the evolution of PPI therapy for EoE and its proposed mechanisms, efficacy and safety in children and adults, and considerations for future PPI precision medicine in patients with EoE.

STRESS ULCER PROPHYLAXIS USING PROTON PUMP INHIBITORS OR HISTAMINE TYPE-2 RECEPTOR ANTAGONISTS IN MECHANICALLY VENTILATED PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: The use of stress ulcer prophylaxis (SUP) is routine in the intensive care unit (ICU) to prevent serious deleterious effects of gastrointestinal bleeding (GIB). There is debate over which choice of drug is safest in the ICU setting for SUP. This literature review looks at the role of proton pump inhibitors (PPIs) compared to histamine type-2 receptor antagonists (H2RAs) and the efficacy of each drug class in regards to clinically significant/overt GIB (CS/O-GIB), ventilator associated pneumonia (VAP), ICU mortality, and ICU length of stay. METHODS: A thorough search of the literature was conducted to perform a meta-analysis of the available studies that investigated the efficacy of PPIs compared to H2RAs in the ICU for SUP among mechanically ventilated patients. This search was performed using PubMed, Embase, and Cochrane for data on the subject matter of study from inception to April 20, 2021. We considered only randomized controlled trials for this analysis. From each study, we collected the number of patients who underwent treatment with either a PPI or H2RA while intubated. The primary outcome was the occurrence of CS/O-GIB. Secondary outcomes were the occurrence of VAP, ICU mortality, and ICU length of stay. The random-effects model was used to calculate the risk ratios (RR), mean differences (MD), and confidence intervals (CIs). A p-value <0.05 was considered statistically significant. Heterogeneity was assessed using Higgins I2 index. RESULTS: Seven randomized controlled trials involving 27905 patients were including in the meta-analysis. The rate of CS/O-GIB was significantly lower in patients receiving PPIs when compared to those receiving H2RAs while intubated (1.6% vs. 2.5%, RR 0.59, 95% CI 0.45-0.79, p= 0.0003, I2= 31%). Five studies reported the rate of VAP, which was not significantly lower in either the PPIs group or the H2RAs group (12.1% vs. 11.4%, RR 1.10, 95% CI 0.74-1.62, p= 0.64, I2= 0%). Five studies reported the rates of ICU mortality in intubated patients, which was not significantly lower in patients receiving PPIs or H2RAs (0.73% vs. 0.70%, RR 1.05, 95% CI 0.86-1.30, p= 0.62, I2= 0%). Four studies reported ICU length of stay, which was found to be similar in both patients receiving PPIs or H2RAs (MD= 0.02 days, 95% CI -0.12-0.16, p= 0.70, I2= 32%). CONCLUSIONS: Our meta-analysis demonstrates that the use of PPIs for mechanically ventilated patients when compared to H2RAs, significantly reduced the rate of CS/O-GIB. The rate of VAP is not significantly lower in either the PPI or H2RA group. Also, there is no significant reduction in the ICU mortality or ICU length of stay when PPIs are used instead of H2RAs. Further data should be collected to confirm our findings. CLINICAL IMPLICATIONS: The use of PPIs in mechanically ventilated patients is effective in preventing CS/O-GIB when compared to H2RAs, without leading to a significant increase in the rate of VAP or ICU mortality. DISCLOSURES: No relevant relationships by Hyder Ali, source=Web Response No relevant relationships by Modar Alom, source=Web Response No relevant relationships by Mohammed Awad, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by prabath herath mudiyanselage, source=Web Response No relevant relationships by Saffa Iftikhar, source=Web Response No relevant relationships by Nithin Kesireddy, source=Web Response No relevant relationships by Waleed Khokher, source=Web Response No relevant relationships by Rakin Rashid, source=Web Response

Performance of the faecal immunochemical test for the detection of colorectal neoplasms and the role of proton pump inhibitors in their diagnostic accuracy.

The faecal immunochemical test (FIT) is currently utilized in both symptomatic and screening populations, but little is known about factors that affect its performance. For example, proton pump inhibitor (PPI) therapy has been purported to increase false negative rates. This has significant implications given the extent of PPI prescriptions. The aim of this work was to evaluate the performance of the FIT for the detection of colorectal neoplasms and the impact of PPI therapy on its diagnostic accuracy. Symptomatic patients referred on the suspected cancer pathway and those on polyp surveillance between 2015 and 2019 were approached to participate. Estimates of the accuracy of FIT at different cut-off levels in diagnosing colorectal neoplasms were made. Logistic regression was used to assess the effect of PPIs on the FIT results. A total of 667 participants were eligible for the final analysis. At a cut-off of 10μg/g faeces, the overall sensitivity and specificity of FIT for the detection of colorectal cancer (CRC) was 0.85 (95% CI 0.71-0.94) and 0.81 (95% CI 0.78-0.84), respectively. For the detection of advanced neoplasia, the sensitivity was 0.70 (95% CI 0.58-0.79) and the specificity was 0.83 (95% CI 0.80-0.86). At higher thresholds, the sensitivity steadily declined whilst specificity increased. PPI therapy did not have a significant effect on performance of the FIT. FIT is a good rule-out test for the detection of CRC and advanced neoplasia at lower thresholds. PPI therapy does not appear to have an effect on its diagnostic performance.

Potential Role of Proton Pump Inhibitors Against Human DRD2 Receptor in Drug Induced Hyperprolactinemia

Dopamine is a catecholamine neurotransmitter that control several important functions via different dopamine receptors(D1-D5). The Dopamine (DRD2) receptor and other D2 family receptors (D3 and D4) are predominantly involved in the inhibitory activities. One vital role of dopamine receptors is its involvement in the endocrine regulations including the hormone synthesis and their secretion. The regulation of prolactin hormone is mainly controlled through DRD2 receptors. Blocking the delivery of dopamine at these DRD2 receptors will cause an increase in serum prolactin levels. PPI�s are among the widely prescribed medications used for multiple gastric hypersecretory disorders and are shown to cause increase in serum prolactin level. This study focuses on computational methods to test PPIs interaction with dopamine D2 receptor through molecular docking &amp; dynamics studies. The 3D structure of protein and the drugs were downloaded from PDB and PubChem databases. Protein and ligands were prepared followed by molecular docking. Complexes with best docking poses were then proceeded towards MD simulations of 60 ns. Results were then analyzed. This study confirmed that there is prospective affinity between proton pump inhibitors and dopamine D2 receptor, and dynamically stable complexes are formed after drug-receptor binding. MD simulations results confirmed the binding affinity between PPIs and Dopamine D2 receptor, concluding that the use of PPIs may be involved in drug induced hyperprolactinemia and other related effects.

The Potential Therapeutic Role of Proton Pump Inhibitors in COVID-19: Hypotheses Based on Existing Evidences.

Although the major therapeutic uses of the proton pump inhibitors are in gastric-acid related diseases, evidences are suggestive of a pleiotropic nature of the compounds. We comment on the probable pathways and cellular machineries via which proton pump inhibitors could show beneficial therapeutic effects against SARS-CoV-2 based on the existing evidences. Proton pump inhibitors have shown antiviral potencies in various in vivo and in vitro studies. Some of the major possible ways through which they can act against SARS-CoV-2 are by exerting anti-inflammatory and anti-fibrotic effects, via vacuolar ATPase pumps leading to raised endolysosomal pH and by targeting endosomal complexes. The current pandemic has put forward a challenge to find treatment options. Although the potential roles of proton pump inhibitors against SARS-CoV-2 have been discussed in recent publications, the clinical evidences for their real-world effectiveness do not point towards a beneficial effect clearly yet. We suggest that although proton pump inhibitors should strongly be considered as potential therapeutic options for COVID-19, larger studies in the form of randomized controlled trials would be required to arrive at a definite conclusion.

The Impact of Direct-to-Consumer Pharmaceutical Advertising on Public Knowledge of Gastroesophageal Reflux Disease: A Study on Over-the-Counter Proton Pump Inhibitors.

BackgroundThe use of direct-to-consumer advertising (DTCA) to promote sales of over-the-counter (OTC) pharmaceuticals used to manage common medical conditions, such as gastroesophageal reflux disease (GERD), is increasing. However, the educational value of these advertisements as well as the public perceptions of this type of advertising remain largely unknown among non-English speaking populations.ObjectiveThe aim of this study was to explore the public perceptions and educational value of a short motion graphic video documenting the lifestyle of person with GERD and presenting a brief introduction to the role of proton pump Inhibitors (PPIs) in relieving the symptoms.MethodsThis was a prospective quasi-experimental study in which a short mock advertising motion graphic video was shown to a sample of adult individuals in malls and shopping centers in different cities across Saudi Arabia. Participants were required to express their levels of agreement with six statements concerning their perceptions of DTCA of OTC drugs, and answer a quiz consisting of three questions and enquiries about their knowledge of GERD and the OTC drugs used in its treatment.ResultsTwo hundred and ninety-five participants were involved in this study, the majority of whom were female (55.30%). After watching the video, the percentages of participants who strongly agreed or agreed that DTCA is a credible source of information and encourages them to purchase the marketed drug have increased significantly (P<0.05). With regard to the quiz, the percentages of participants with correct answers regarding the definition of GERD, knowledge of OTC drugs for GERD, and awareness of the common side effects of PPIs increased from 81.69% to 95.93%, 69.83% to 96.27%, and 46.44% to 91.53%, respectively (P<0.0001).ConclusionDTCA of OTC drugs for GERD, particularly if the content complies with the regulatory requirements, can promote the public knowledge of the disease and treatment options.

The Role of Proton Pump Inhibitors in the Development and Course of Pneumonia

The Role of Proton Pump Inhibitors in the Development and Course of Pneumonia

Enteral nutrition better than proton pump inhibitors?

Stress ulcer prophylaxis in critically-ill patients has been a subject of extensive research, with multiple clinical trials attempting to study the best method of stress ulcer prophylaxis with the least adverse effects. Until recently, pharmacologic prophylaxis has prevailed as the primary choice for the prevention of stress ulcers but recent clinical studies have attempted to evaluate the role of enteral nutrition in stress ulcer prophylaxis. The incidence of stress ulcers that result in clinically important gastrointestinal bleeding (CIGIB) has drastically decreased over the last two decades. Furthermore, in the current era CIGB in the ICU does not seem to be associated with an increased mortality. Multiple recent clinical studies aimed to evaluate the role of proton pump inhibitors (PPIs) in patients who tolerate enteral nutrition in the ICU. The results of multiple recent clinical studies call for re-evaluation of the routine use of PPIs in critically ill patients who tolerates enteral nutrition in the ICU. Despite the promising preliminary results, definitive recommendations need larger clinical trials that are powered to evaluate any added benefits of using PPI in critically ill patients who tolerate enteral nutrition given the low incidence of CIGB in the current era.

DOZ047.120: The role of proton-pump inhibitors in eosinophilic esophagitis: focus on esophageal atresia children

Abstract Introduction Since recently, after detection of eosinophilic predominant inflammation of esophagus a trial with proton-pump inhibitors (PPIs) was needed to individuate children with PPI-responsive esophageal eosinophilia (PPI-REE), only those non-responders received eosinophilic esophagitis (EoE) diagnosis. In 2018 updated international consensus suggested removing the PPI trial as a diagnostic criterion and consider PPIs as a treatment together with diets and topical steroids. The role of PPIs is evaluated in children with esophageal atresia (EA) and EoE versus EoE from general population. Method A retrospective chart review of both children with EA and EoE followed-up from at January 2005 has been performed. According to ESPGHAN guidelines published in 2014 patients showing eosinophilic inflammation received high-dose PPI trial to identified PPI-REE. Those non-responders were labeled as EoE and underwent to dietary and/or topical steroid treatment. Demographics and disease characteristics of EA patients with EoE were analyzed and compared with those with EoE from general population. Results Overall, 370 EA and 118 EoE patients were analyzed. Of them 15 EA-EoE patients were detected. Consequently, in our cohorts, 4.0% of EA patients developed EoE. Male-to-female prevalence ratio was of 2.55 with no difference in gender prevalence between groups. At diagnosis EoE-EA children were significantly younger compared to EoE group (mean: 5.1 vs 10.8 years; P &lt; 0.0001). Peak EOS/HPF at diagnosis did not differ between groups (50.1 ± 26 vs 59.8 ± 29 EOS/HPF). No difference was observed in allergy prevalence between groups (53.8 vs 68.0%). PPI-REE was significantly more prevalent in EA-EoE group that in EoE group (66.6% vs 19.4%; P = 0.0004). Conclusion Similar gender distribution and high prevalence of allergy suggest that common genetic susceptibility factors for EoE exist. However, high prevalence of PPI-REE coupled early EoE onset might also suggest that other factors (e.g. esophageal motility disorders) might play a physiopathological role in EoE development in EA children. Our study suggests that a stepwise approach with PPIs as a first-line treatment for EoE management in EA children should still be considered.

Rola inhibitorów pompy protonowej w uszkodzeniu nerek – ryzyko stosowania preparatów OTC

Rola inhibitorów pompy protonowej w uszkodzeniu nerek – ryzyko stosowania preparatów OTC

Mucosal healing after high dose pantoprazole in acute corrosive injury of esophagus

INTRODUCTION : The ingestion of corrosive agents is still an important public health issue in our country. The GIT injuries caused by caustic agents can range from minor to fatal, or can lead to chronic disease with poor quality of life. Corrosive agents with a pH level less than two or more than twelve can rapidly penetrate the layers of the oesophagus and result in necrosis and scar formation in the mucosa. Acidic agents produce coagulation necrosis and eschar formation that may limit tissue penetration and may even spare the oesophagus when the transit is rapid. On the other hand, Alkaline agents when ingested produce liquefaction necrosis and can cause serious oesophageal injury by penetrating to deep muscle layers. The basic histopathologic reaction of tissue subjected to caustic burn is the synthesis, deposition and remodelling of collagen. Following full-thickness injuries to the oesophageal wall, the normal oesophagus is replaced by dense connective tissue. Collagen overproduction has been estimated to cause stenosis in half of the patients suffering severe burns. Consequently, when treating caustic burn injuries, it is necessary to prevent stenosis by inhibiting collagen synthesis or changing the properties of the deposited collagen. The optimal management protocol in the treatment of severe caustic injury remains controversial. The main goal of medical treatment is to inhibit inflammatory reaction or stricture formation secondary to oesophageal burning. Stricture formation is thought to be overcome by suppressing fibroplasia and scarring. Many agents directed at wound healing and stricture prevention have been used in several experimental studies in past. Results of such treatment protocols including steroids, antibiotics, heparin, indomethacin, sucralfate, vitamin E, as well as total parenteral nutrition are all controversial in treatment of corrosive burns. Randomised control trials on the role of proton pump inhibitors in caustic injuries of GIT are lacking. A few experimental studies have investigated the relationship between proton pump inhibitors and corrosive burns and has shown that proton pump inhibitors can reduce inflammation in early phase of caustic injury. Proton pump inhibitors, by decreasing gastric acid secretion and thereby GER can prevent worsening of corrosive injury. In addition proton pump inhibitors has also been shown to have anti-inflammatory and antioxidant properties. A prospective study from turkey on 13 patients have showed that omeprazole can be used effectively in treatment of acute corrosive injury of esophagus. There are no studies from India which have attempted to assess the usefulness of proton pump inhibitors in treatment of acute corrosive injury of esophagus. This prompted us to study the usefulness of pantoprazole in the treatment of patients presenting with acute corrosive injury of the oesophagus. AIM OF THE STUDY : To study the efficacy of high dose pantoprazole in causing mucosal healing after acute corrosive injury of esophagus. CONCLUSION : Treatment of corrosive injury is controversial and there are no definitive protocols. Intravenous proton pump inhibitors are widely used in treatment of corrosive injuries despite lack of evidence. Our study has demonstrated that effective mucosal healing can be achieved by intravenous proton pump inhibitor infusion. Though majority of patients in our study had minor grade of injury, 27% of the patients included in the study had 2b and 3a injury. When analysis is confined to these patients, 53% showed improvement by 1 grade, 33.3% showed improvement by 2 grades and 13.3% did not show improvement. Therefore it is evident from above that high dose pantoprazole is also beneficial in patients with higher grade of injury and may prevent late complications in these patients. A larger randomised placebo controlled trial in patients with higher grade of oesophageal injury is needed to determine if high dose pantoprazole should form standard of care in treatment of patients with acute corrosive injury of oesophagus.