Head-to-head comparison of H2-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: A meta-analysis

Aim: To systematically evaluate the efficacy of H2-receptor antagonists (H2RAs) and proton pump inhibitors in healing erosive esophagitis (EE). Methods: A meta-analysis was performed. A literature search was conducted in PubMed, Medline, Embase, and Cochrane databases to include randomized controlled head-to-head comparative trials evaluating the efficacy of H2RAs or proton pump inhibitors in healing EE. Relative risk (RR) and 95% confidence interval (CI) were calculated under a random-effects model. Results: RRs of cumulative healing rates for each comparison at 8 wk were: high dose vs standard dose H2RAs, 1.17 (95%CI, 1.02-1.33); standard dose proton pump inhibitors vs standard dose H2RAs, 1.59 (95%CI, 1.44-1.75); standard dose other proton pump inhibitors vs standard dose omeprazole, 1.06 (95%CI, 0.98-1.06). Proton pump inhibitors produced consistently greater healing rates than H2RAs of all doses across all grades of esophagitis, including patients refractory to H2RAs. Healing rates achieved with standard dose omeprazole were similar to those with other proton pump inhibitors in all grades of esophagitis. Conclusion: H2RAs are less effective for treating patients with erosive esophagitis, especially in those with severe forms of esophagitis. Standard dose proton pump inhibitors are significantly more effective than H2RAs in healing esophagitis of all grades. Proton pump inhibitors given at the recommended dose are equally effective for healing esophagitis. © 2005 The WJG Press and Elsevier Inc. All rights reserved.published_or_final_versio

Proton-pump inhibitors

Proton-pump inhibitors (PPIs) are a class of drugs that profoundly suppress gastric acid secretion, and thus have become the treatment of choice for gastro-oesophageal reflux disease and peptic ulcer disease. PPIs are considered safe and effective. It is essential that clinicians understand the appropriate use of PPIs, given the significant economic burden of inappropriate prescribing and safety concerns. Long-term safety concerns and possible drug interactions have led to a more conservative approach to PPI use. Some of these concerns may have been overstated, but they serve to highlight the need for ongoing vigilance because even a small increased risk of an adverse event may translate to a large number, considering that the use of PPIs is widespread. This review focuses on the use of oral PPIs in the ambulatory setting, and recent concerns regarding the adverse effects of PPIs.Keywords: proton-pump inhibitors, PPIs, gastro-oeseophageal reflux disease, GORD, PU

Proton Pump Inhibitors and Corticosteroids as Synergistic Risk Factors for Candida Esophagitis

Abstract: Introduction: Inhaled & systemic steroids are one of the well-documented risks factors for Candida esophagitis. However, the role of gastric acid suppression remains controversial. Methods: We conducted a retrospective case-control study of 420 patients consisting of 84 cases of Candida esophagitis and 336 matched controls. Our cohort was gathered from subjects evaluated from 2001 to 2012. The diagnosis of Candida esophagitis was based on endoscopic and/or histological criteria. Results: On univariate analysis, proton pump inhibitors were associated with higher risk (OR = 2.14; 95 % CI: 1.30 to 3.54); steroid use also increased the risk (OR = 3.55; 95% CI: 2.10 to 6.00). Furthermore, concurrent use of proton pump inhibitors & steroids substantially raised this risk (OR = 13.8; 95% CI 5.07 to 37.5), suggesting a synergistic effect. When adjusted for covariates (cancer, chemotherapy/radiation, antibiotic use, hypothyroidism, anemia, chronic liver disease & diabetes), anemia decreased the odds ratio for proton pump inhibitors to 1.67 (95% CI 1.02 to 2.75) and steroids to 1.69 (95% CI to 1.03 to 2.87). Hypothyroidism also substantially reduced the observed risk associated with steroid use. However, neither anemia nor hypothyroidism reduced the odds ratio for combined use of steroids and proton pump inhibitors. Conclusions: Our data suggests that patients who have been treated with steroids or proton pump inhibitors are at an increased risk for developing Candida esophagitis. Our data also suggests that steroids and proton pump inhibitors act synergistically to greatly increase the likelihood of Candida esophagitis

Inappropriate use of proton pump inhibitors in non-critical indoor patients in a tertiary care teaching hospital in Eastern India

Background: Proton pump inhibitors are one of the most commonly used drugs worldwide. Often they are used for inappropriate indications too, imposing economic burden to patients and governments. Many studies have showed equipotent efficacy of oral and intravenous proton pump inhibitor therapy. Despite that, most of the hospitalized patients receive intravenous proton pump inhibitor without appropriate indications. This study aimed to assess use of proton pump inhibitors in government hospital.Methods: It was an observational cross-sectional study done in the general medicine department of a tertiary care teaching hospital in Eastern India, including 800 noncritical patients. Objective was to assess the use of proton pump inhibitors (indications, route of administration, dosing frequency).Results: 100% patient received intravenous proton pump inhibitor irrespective of diagnosis. 80% of them received it twice daily and 18% received it once daily. Majority of the patients received intravenous proton pump inhibitor despite taking other drugs by oral route.Conclusions: Most of the PPI administration was done without appropriate indication. All patients received Intravenous proton pump inhibitors, which may impose economic burden on a government hospital. Majority of the patients received proton pump inhibitors twice daily. These approaches are not cost effective and need to be rectified

Proton Pump Inhibitors: Omeprazole

Characteristics and uses of proton pump inhibitors are discussed, specifically, the drug omeprazole, a type of proton pump inhibitor, is discussed, including the chemistry, it\u27s uses and side effects

Proton pump inhibitors are associated with increased risk of development of chronic kidney disease

Background Acute interstitial nephritis secondary to proton pump inhibitors (PPIs) frequently goes undiagnosed due to its subacute clinical presentation, which may later present as chronic kidney disease (CKD). We investigated the association of PPI use with the development of CKD and death. Methods Two separate retrospective case–control study designs were employed with a prospective logistic regression analysis of data to evaluate the association of development of CKD and death with PPI use. The population included 99,269 patients who were seen in primary care VISN2 clinics from 4/2001 until 4/2008. For evaluation of the CKD outcome, 22,807 with preexisting CKD at the first observation in Veterans Affairs Health Care Upstate New York (VISN2) network data system were excluded. Data obtained included use of PPI (Yes/No), demographics, laboratory data, pre-PPI comorbidity variables. Results A total of 19,311/76,462 patients developed CKD. Of those who developed CKD 24.4 % were on PPI. Patients receiving PPI were less likely to have vascular disease, COPD, cancer and diabetes. Of the total of 99,269 patients analyzed for mortality outcome, 11,758 died. A prospective logistic analysis of case–control data showed higher odds for development of CKD (OR 1.10 95 % CI 1.05–1.16) and mortality (OR 1.76, 95 % CI 1.67–1.84) among patients taking PPIs versus those not on PPIs. Conclusions Use of proton pump inhibitors is associated with increased risk of development of CKD and death. With the large number of patients being treated with proton pump inhibitors, healthcare providers need to be better educated about the potential side effects of these medications

A systemic literature review of the effect of proton pump inhibitors on gallbladder function

Objective: To determine the association between proton pump inhibitors and gallbladder function Methods: A systematic search of Medline, Embase and CENTRAL (inception to April 2020) was conducted to capture the relevant studies. A comprehensive inclusion-exclusion criterion was developed and implemented to screen the titles and abstracts. . We, however, found no eligible studies. Results: The systematic search identified 38 unique articles for title and abstract screening. Of which, five were included as potentially relevant studies. However, upon full-text screening, none of them met our inclusion criteria. This review is, therefore, an empty systematic review. Conclusion: There are no good quality studies determining the effect of proton pump inhibitors on gallbladder function. Given the common use of proton pump inhibitors and their potential impact on gallbladder function, there is an urgent need for conducting clinical studies to address this gap in the evidence

Esophageal sphincter device for gastroesophageal reflux disease

BACKGROUND Patients with gastroesophageal reflux disease who have a partial response to proton-pump inhibitors often seek alternative therapy. We evaluated the safety and effectiveness of a new magnetic device to augment the lower esophageal sphincter. METHODS We prospectively assessed 100 patients with gastroesophageal reflux disease before and after sphincter augmentation. The study did not include a concurrent control group. The primary outcome measure was normalization of esophageal acid exposure or a 50% or greater reduction in exposure at 1 year. Secondary outcomes were 50% or greater improvement in quality of life related to gastroesophageal reflux disease and a 50% or greater reduction in the use of proton-pump inhibitors at 1 year. For each outcome, the prespecified definition of successful treatment was achievement of the outcome in at least 60% of the patients. The 3-year results of a 5-year study are reported. RESULTS The primary outcome was achieved in 64% of patients (95% confidence interval [CI], 54 to 73). For the secondary outcomes, a reduction of 50% or more in the use of proton-pump inhibitors occurred in 93% of patients, and there was improvement of 50% or more in quality-of-life scores in 92%, as compared with scores for patients assessed at baseline while they were not taking proton-pump inhibitors. The most frequent adverse event was dysphagia (in 68% of patients postoperatively, in 11% at 1 year, and in 4% at 3 years). Serious adverse events occurred in six patients, and in six patients the device was removed. CONCLUSIONS In this single-group evaluation of 100 patients before and after sphincter augmentation with a magnetic device, exposure to esophageal acid decreased, reflux symptoms improved, and use of proton-pump inhibitors decreased. Follow-up studies are needed to assess long-term safety. (Funded by Torax Medical; ClinicalTrials.gov number, NCT00776997.