Production of stomach acid is a valuable and natural chemical contributor to the digestion process. But overproduction of acid leads to the formation of an ulcer in stomach, oesophagus and duodenum (first part of the small intestine) with GERD (Gastroesophageal reflux disease).
What is GERD?
GERD is one of the most common medical conditions with an estimated prevalence of 10 – 20% in the world. It is the burning sensation due to backing up of acid from the stomach towards the throat. GERD is associated with decreased work productivity, reduced quality of life and places a substantial financial burden on society.
Lifestyle management in the treatment of ulcers and GERD include:
- Intake of proper diet and avoiding spicy foods, coffee and fruits containing excessive amount of acid.
- It is better to take several meals in a day instead of getting 2-3 large meals.
- Do not smoke and chew tobacco because it can make GERD worse.
Lifestyle changes are beneficial to manage the ulcers as well as gastroesophageal reflux disease. However, medications are required at chronic condition.
Proton pump inhibitors are the most common and widely prescribed class of medicines for the treatment of acid-related disorders (ulcers) as well as heartburn (burning pain in the lower chest) which accompanies GERD.
Proton pump inhibitors (PPIs) heal the existing ulcer and prevent the new ulcer formation. PPIs usually take a longer time to treat your symptoms as compared to H2 (Histamine) receptor blockers, but symptoms relief from PPIs last longer.
Different Proton Pump Inhibitors:
There are various proton pump inhibitors like omeprazole, pantoprazole, rabeprazole, lansoprazole, esomeprazole etc.
Omeprazole and lansoprazole have been used for a long time and now have become over-the-counter (OTC) drugs. Pantoprazole and rabeprazole are relatively newer medications and have better acid suppression action as compared to omeprazole.
All PPIs have similar mechanism of action towards disease symptoms, but they possess different metabolism and drug interactions patterns. Newer generation PPIs have better, and more prolonged acid suppression as compared to the older PPIs and offer sustained action hence, dose frequency is reduced.
How do they work?
- There are millions of parietal cells which are consistently produced in the stomach, so inhibition of acid production is nearly infeasible.
- Proton pump inhibitors decrease the production of acid by blocking the enzyme responsible for acid production in the parietal cells.
- They inhibit the enzyme known as H+/K+ ATPase, which controls the acid production. This enzyme is also called proton pump and present in the parietal cells of the stomach wall.
- Blocking, as well as a reduction in acid production gives time to heal the existing ulcer.
- PPIs are most powerful medications for the prevention of burning sensation (heartburn), which accompanies GERD.
- Treatment of ulcer – These are used in the treatment of oesophageal, stomach and duodenal ulcers.
- Treatment of GERD – In case of GERD (Gastroesophageal reflux disease), PPIs are preferred for the treatment.
- Prevent NSAID associated ulcers – PPIs are effective in the prevention of NSAID (a non-steroidal anti-inflammatory drug) – associated ulcers and ulcer bleeding.
- Treatment of Zollinger-Ellison syndrome – PPIs are used in the treatment of Zollinger-Ellison syndrome (conditions associated with overproduction of acid).
- Eradication of Helicobacter pylori Infection – PPIs is also used in combination with antibiotics for the destruction of the bacteria Helicobacter pylori, which together with acid, causes an ulcer.
- Treat Dyspepsia – These are also used in dyspepsia and gastritis.
Dosage of Proton pump inhibitors:
- PPIs are generally well tolerated with a convenient once in a day dosing schedule.
These are available in the form of tablets and capsules.
- Generally, these are taken 30 minutes before the meal in the morning because parietal cells of the stomach (responsible for acid production) become activated in response to the meal.
- The standard dose of PPIs is 20 mg for lansoprazole, 30 mg for lansoprazole, 40 mg for pantoprazole and 20 mg for rabeprazole.
If you are suffering from peptic ulcer, then your doctor may prescribe PPIs with other medicines for two weeks.
Side effects related to Proton pump inhibitors:
- Proton pump inhibitors are generally safe and well-tolerated, but the common side effects include abdominal pain, headache, nausea, vomiting, constipation and diarrhea.
- Other serious side effects associated with PPIs are reduced liver and kidney functions, pancreatitis, erythema, severe allergic reactions and Stevens-Johnson syndrome.
- Increase in the dose and long term use (more than one year) can increase the risk of osteoporosis-related fractures and also reduces the absorption of cyanocobalamin (vitamin B12). If you have side effects from one PPI, it is not necessary that it will occur with another PPI too. So it is essential to discuss with your physician before switching to another PPI.
Availability of cost-effective Proton pump inhibitors
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