Proton pump inhibitors (PPIs) are a group of drugs used in the treatment of diseases of the upper gastrointestinal tract, mainly in the prevention and treatment of gastric and duodenal ulcers, but also reflux and heartburn. What are the effects of overuse of proton pump inhibitors?

Proton pump inhibitors(PPIs) inhibit the production of hydrochloric acid by the proton pump, which is found in the parietal cells of the gastric mucosa. PPIs are definitely stronger and more effective than other drugs available to inhibit the secretion of this acid.

Proton pump inhibitors rarely cause side effects, and if even, most often in the form of harmless gastrointestinal disorders. This is one of the reasons why they are medications very often prescribed by doctors, and one of them, omeprazole, is on the World He alth Organization's list of essential medicines.

In addition to omeprazole, proton pump inhibitors include:

  • pantoprazole,
  • dexlansoprazole,
  • lansoprazole,
  • rabeprazol
  • and esomeprazole.

These are benzimidazole derivatives that have a similar effectiveness to it. The only difference is the amount of time it takes for acid secretion to be halved.

The full effect of their operation can be observed after a few days of use, but it lasts up to 72 hours.

Proton pump inhibitors: indications and use

Proton pump inhibitors are used mainly in the treatment of the aforementioned duodenal ulcer or gastric ulcer and, which should be emphasized, in the prevention of their recurrence (primarily as a prevention of ulcers caused by taking non-steroidal anti-inflammatory drugs, especially among people at high risk ).

They are also used in the long-term treatment of peptic ulcer, including bleeding ulcers. What's more, together with antibacterial drugs, they are part of the combined treatment of peptic ulcer disease in people infected with the bacteriumHelicobacter pylori .

PPIs are also drugs of first choice for the treatment of acid reflux disease (reflux oesophagitis, gastroesophageal reflux disease), which is manifested mainly by the reflux of gastric acid into the stomach.esophagus and heartburn.

Proton pump inhibitors are also recommended in the case of Zollinger-Ellison syndrome and other diseases caused by excessive secretion of hydrochloric acid (usually with numerous erosions and ulcers).

PPIs are also used in some people as a prophylactic measure for aspiration pneumonia.

These types of medications are usually taken orally by patients. However, some of them are also administered intravenously (e.g. solution for infusion with omeprazole, esomeprazole or pantoprazole).

It is recommended to take PPIs once a day - just before or with food (except for lansoprazole). Then the gastric parietal cells are most active and secrete the most hydrochloric acid. It is important because the acidic environment is a factor necessary for the activation (transformation of inactive precursors into active sulfonamides) of the proton pump inhibitors.

Treatment of PPIs typically takes several weeks and is long-term.

Proton pump inhibitors: side effects

Proton pump inhibitors are generally well tolerated by most patients. Their use rarely causes side effects. Among them, however, patients most often mention gastrointestinal complaints, mainly gastrointestinal disorders, e.g.

  • nausea and vomiting
  • diarrhea
  • stomach pains
  • constipation
  • flatulence

There are also headaches. Rarely seen:

  • dizziness
  • increase in liver enzymes
  • sleep disturbance
  • feeling unwell
  • skin rashes and itching (in patients allergic to the active ingredient)
  • joint pains

There may be, in individual cases, severe hearing and vision impairment. Such side effects rarely occur in patients after parenteral administration of PPIs.

A small percentage of patients (a few percent) experience increased acid secretion and secondary hypergastrinemia after PPI therapy.

Taking PPIs longer than a year may cause magnesium deficiency in the body.

In isolated cases, when taking PPIs, patients reported side effects such as:

  • aggression
  • hallucinations
  • depression
  • arousal
  • dry mucous membranes
  • stomatitis
  • photosensitivity
  • black color of the tongue
  • entanglement
  • gastrointestinal yeast infection

At the time the drugs of the groupproton pump inhibitors are used for a long time, it may lead to the development of atrophic gastritis, especially if there is also a bacterial infectionHelicobacter pylori . In this case, changes in the structure of the mucosa may also appear.

Overdosing with this group of drugs is extremely rare. Then, gastrointestinal symptoms and weakness are observed. Treatment is only symptomatic, as there is no specific antidote, and haemolysis does not accelerate the elimination of the drug from the body.

Experts have linked long-term PPI intake with a higher probability of developing cardiovascular disease, chronic kidney disease, and cancers of the upper gastrointestinal tract, including stomach cancer. Such conclusions were drawn by scientists from the Washington University School of Medicine in St. Louis and Veterans Affairs St. Louis He alth Care System.¹

Contrary to some opinions, no disturbances in the absorption of iron and other trace elements have been observed during the use of PPIs, only in patients with Zollinger-Elison syndrome there may be a difficult absorption of vitamin B12, then its supplementation should be considered.

It should be remembered, however, that the reactions to the medications taken may be significantly different, everything depends on the patient's disease, comorbidities and other medications taken at the same time.

Proton pump inhibitors: interactions

Proton pump inhibitors can affect how other drugs work. They cause a change in the pH of gastric juice, which changes the absorption of other drugs. PPIs can also affect the metabolism of other medications. As a result of lowering the pH, the absorption of antibacterial drugs may increase.

For the same reason, ketoconazole or itraconazole are less well absorbed - because they need an acidic environment. Lansoprazole may reduce the concentration of theophylline used, for example, in asthma.

Patients who take oral coumarin-derived anticoagulants (phenprocoumon, warfarin) orally are at increased risk of bleeding.

In contrast, clarithromycin used in respiratory tract infections may increase PPI levels, and for example rifampicin or preparations containing St. John's wort may decrease lansoprazole levels.

Proton pump inhibitors: abuse

A separate and important problem is the abuse of PPIs and the unnecessary use of these drugs, i.e. in the absence of any indications. Especially when patients use them "on their own", without consulting a doctor.Unfortunately, this happens very often.

PPIs are the second most prescribed medications in the world, after statins (cholesterol lowering drugs), but efforts are being made to reduce this scale.

It is worth adding that long-term treatment of PPIs may cause changes in the composition of the intestinal bacterial flora. This, in turn, increases the risk of developing bacterial overgrowth, irritable bowel syndrome, and infectious bowel diseases. Especially in weakened people.

Therefore, specialists emphasize the need to periodically control the indications for extending PPI therapy and striving to use the lowest effective dose or, if necessary, change the drug.

Natural proton pump inhibitors

There are also natural substances and products that can inhibit the production of hydrochloric acid in the stomach. These include, for example :

  • baking soda
  • watermelon juice
  • apple cider vinegar
  • aloe vera juice

However, if the symptoms persist or even worsen, it is necessary to visit a doctor, specialist tests and start pharmacological treatment.

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