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Posted by on May 11, 2013 in The Treatments |

Proton Pump Inhibitors

Proton Pump Inhibitors

This post is still under construction.

Disregard its content, if any, as it only contains raw reference material for the future post.

Questions about PPIs? Head for the forum

Watch this 17 sec. video to get the gist of PPI's

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Controlling acid production

Imagine you're watering your little patch of grass you call your garden  using a water hose.  But you have been at it for a while now, and, if you carry on with the hose, you're going to turn your garden into a swimming pool. What are the 2 most effective ways to stop the water?

You can cut off the water supply at the the tap (stopping water production) or you can cut off the water supply at the nozzle (stopping water egress).

Both actions have the same effect, but the way the effect is achieved is different.

The same is true with cutting off acid supply into the stomach. You can block the cells which produce the acid. Or you can let the cells produce acd, but block the flow of the acid into the stomach.

Preventing the production of acid is done through h2 blockers.  Preventing produced acid from flowing into the stomach is done through Proton pump inhibitors.

In the video above,

 

Slow, long term
delayed onset a couple of hours
can relieve symptoms for up to 3 days
Omeprazole (prilosec)
Lansoprazole (Prvacid)
Rabeprazole (Aciphex)
Pantoprazole (Protonix)
Esomepraxole (nexium)
Zegarid (rapid release of omeprazole
diarrhea, Nausea, Headache, abdominal pain
Ulcers, GERD, Esophagitis
H2 Blockers
Sore throat, diarrhea, Nausea, Headache, Weakness

There is evidence that prolongued use causes hip fractures of 18% for H2 30% PPI
Mild Heartburn, try and be on the lowest effective dose due to altered calcium absorption
Proton Pump Inhibitors and Histamine-2 Receptor Antagonists Are Associated With Hip Fractures Among At-Risk Patients http://www.gastrojournal.org/article/S0016-5085(10)00488-9/abstract

PPI Some agents in this group include: Omeprazole (Losec, Prilosec, Zegerid, ocid); Lansoprazole (Prevacid, Zoton, Inhibitol); Esomeprazole (Nexium); Pantoprazole ( Protonix, Somac, Pantoloc, Pantozol, Zurcal, Pan); Rabeprazole ( Rabecid, Aciphex, Pariet, Rabeloc)

The proton pump is the terminal stage in gastric acid secretion, being directly responsible for secreting H+ ions into the gastric lumen, making it an ideal target for inhibiting acid secretion. (“Irreversibility” refers to the effect on a single copy of the enzyme; the effect on the overall human digestive system is reversible, as the enzymes are naturally destroyed and replaced with new copies.)

Targeting the terminal-step in acid production, as well as the irreversible nature of the inhibition, result in a class of drugs that are significantly more effective than H2 antagonists and reduce gastric acid secretion by up to 99%.

PPIs include:
Aciphex (raberprazole)
Dexilant (dexlansoprazole)
Nexium (esomeprazole)
Prevacid (lansoprazole)
Prilosec (omeprazole)
Protonix (pantoprazole)

How are PPIs different from H2 Blockers?

Both PPIs and H2 Blockers suppress gastric acid secretion. They are different, however, in how they do this. While PPIs shut down the proton pumps in the stomach, H2 Blockers work by blocking the histamine receptors in acid producing cells in the stomach.
PPIs have a delayed onset of action, while H2 blockers begin working within an hour. PPIs work for a longer period of time; most up to 24 hours and the effects may last up to three days. H2 Blockers, however, usually only work up to 12 hours.

Question: What Are H2 Blockers?
Answer:
Your doctor may also prescribe a Proton Pump Inhibitors (PPIs). There has been some confusion as regards these two medications because some people assume they work the same and are interchangeable. While both PPIs and H2 blockers suppress gastric acid secretion, they work at different stages of production.. While histamine blockers block one of the first stimuli for acid production, proton pump inhibitors block the final step in the pathway of acid secretion in the stomach, resulting in greater suppression of acid. PPIs shut down the proton pumps in the stomach, H2 blockers work by blocking the histamine receptors in acid producing cells in the stomach. PPIs have a delayed onset of action, while H2 Blockers begin working within an hour. PPIs work for a longer period of time; most up to 24 hours and the effects may last up to three days. H2 Blockers, however, usually only work up to 12 hours.

Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: results from the Women’s Health Initiative
Gray SL, LaCroix AZ, Larson J, Robbins J, Cauley JA, Manson JE, Chen Z.
Arch Intern Med. 2010 May 10;170(9):765-71.

Increase in vertebral fracture risk in postmenopausal women using omeprazole
Roux C, Briot K, Gossec L, Kolta S, Blenk T, Felsenberg D, Reid DM, Eastell R, Glüer CC.
Calcif Tissue Int. 2009 Jan;84(1):13-9. Epub 2008 Nov 21.
n an article (Doornebal J, et al. Ned Tijdschr Geneeskd .2009;153; 153:A7110), published in the Netherlands, the authors stated that the long term use of proton pump inhibitors could lead to serious hypomagnesemia.
Long-term proton pump inhibitor therapy and risk of hip fracture
Yang YX, Lewis JD, Epstein S, Metz DC.
JAMA. 2006 Dec 27;296(24):2947-53.
A case series of proton pump inhibitor-induced hypomagnesemia
Hoorn EJ, van der Hoek J, de Man RA, Kuipers EJ, Bolwerk C, Zietse R.
Am J Kidney Dis. 2010 Jul;56(1):112-6. Epub 2010 Feb 26.

Concern About Iron Interference
In a couple of recent articles, the impact that proton pump inhibitors can have on iron status was highlighted. In the first study [Hutchinson, et al: Gut. 56(9):12915], the researchers point out that during long term treatment of hereditary hemachromatosis, they observed that the use of proton pump inhibitors reduced the requirement for maintenance phlebotomy.