Proton Pump Inhibitors (PPIs) Drugs Such as Prilosec (Omeprazole)
Two decades ago, medical treatment of peptic ulceration was limited to sustained and burdensome use of antacids supplemented by anticholinergic agents and, more speculatively, changes in diet and lifestyle. Healing was an uncertain process; recurrence and relapse were
common; scarring often resulted in gastric outlet obstruction; while haemorrhage and perforation were frequent life-threatening events.
Some tasty holiday treats may leave you reaching for the antacids instead of another turkey drumstick. And for the 15 million Americans who experience chronic heartburn, or Gastroesophageal Reflux Disease (GERD), the holidays can be especially painful.
Gastroesophageal reflux disease (GERD) is a condition that causes your esophagus to be irritated and inflamed because of acid backing up from your stomach. Gastroesophageal reflux is a common condition that often occurs without symptoms after meals. In some people, the reflux is related to a problem with the lower esophageal sphincter, a band of muscle fibers that usually closes off the esophagus from the stomach. If this sphincter doesn't close properly, food and liquid can move backward into the esophagus and may cause the symptoms.
Frequent, strong heartburn is one of the signs of gastroesophageal reflux disease, more commonly known as GERD or acid reflux. GERD doesn't just affect older people who eat too much while watching TV. Active, healthy teens can have GERD, too.If your doctor suspects you might have GERD, he or she may refer you to a pediatric gastroenterologist, a doctor who treats kids and teens who have diseases of the gastrointestinal system (the esophagus, stomach, intestines, and other organs that aid in digestion).
Secretion of acid was recognized as an essential prerequisite, but whereas duodenal ulceration was shown to be strongly associated with raised or high-normal output of acid, this relationship was not found to apply to gastric ulceration which was tentatively attributed to impaired “mucosal resistance”. On the basis of these two postulated mechanisms a range of highly effective ulcer-healing drugs has been developed.
For some teens, doctors advise combining medications to control different symptoms. For example, people who get heartburn after eating can try taking both antacids and H2 blockers. The antacid goes to work first to neutralize the acid in the stomach, while the H2 blocker acts on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production.
Effective H2-receptor antagonists are — cimetidine , ranitidine, famotidine , and nizatidine — which reversibly reduce output of gastric acid by blocking histamine H2 receptors. More recently introduced are the “proton pump” inhibitors, exemplified by omeprazole, lansoprazole and pantoprazole, which block adenosine triphosphatase-driven hydrogen/ potassium exchange within the parietal cells.
The introduction of H2 blockers revolutionized the treatment of duodenal ulcers . Since then, several H2 blockers with improved healing rates have been introduced . In the search for newer and better drugs, prostaglandin was introduced, but the drug did not fulfil expectations. The introduction of proton pump inhibitors has reduced the duration of treatment of duodenal ulcers by almost 50%.
These substances are the most effective inhibitors of acid production that have yet been devised. In most, but not all studies, they have induced healing of duodenal ulcers more rapidly than H2- receptor antagonists, but this advantage is less apparent in gastric ulcer. Omeprazole has been used with particular success in treating severe fibrosing and erosive oesophagitis, a condition in which treatment with H2 -receptor antagonists is often disappointing.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.
If your baby is uncomfortable, the doctor may prescribe infant doses of medications commonly used to treat heartburn in adults. Choices may include H-2 blockers, such as cimetidine (Tagamet) or ranitidine (Zantac), or proton pump inhibitors, such as esomeprazole (Nexium) or omeprazole (Prilosec). Although these medications are considered safe for use in infants and children with GERD, a 2006 study noted an increased risk of intestinal and respiratory infections in otherwise healthy children taking these medications.
But most recently according to a report in The Journal of Pediatrics expressed satisfaction for long-term use of proton pump inhibitors (PPIs)--drugs such as Prilosec (omeprazole) and Prevacid (lansoprazole) that are used to stop stomach acid from "refluxing" into the esophagus--appears to be safe and effective in children.
"PPIs are drugs that have revolutionized the practice of pediatric gastroenterology, and they have a wide margin of safety," study co-author Dr. Eric Hassall from BC Children's Hospital/University of British Columbia, Vancouver, told Reuters Health. "However, long-term use needs to be justified by an established diagnosis, and repeated attempts at withdrawal."
Hassall and associates characterized 166 pediatric patients with reflux disease who received PPIs at their institution for up to 11 years.
Most patients used omeprazole only, but a few used lansoprazole, the report indicates, and more than 90 percent of patients in the study used the PPI for more than 30 days.
Among 136 patients taking a PPI continuously, the duration of use ranged from 273 days to 11.24 years, the researchers note. Doses ranged from 4 mg to 90 mg daily.
Only six patients eventually required antireflux surgery due to poor response to PPI therapy, the authors report, and only six signs or symptoms possibly related to PPI use were seen in four patients.
"Preliminary data in adults show some potential concerns about an increased rate of some infections, B12 deficiency, and iron and calcium malabsorption," Hassall explained.
"As yet there are no guidelines for checking these parameters in children, but it's particularly important that pediatric long-term PPI patients receive nutritional advice regarding these nutrients, and it may be advisable to check iron and B12 status once a year."
"Use PPIs carefully -- in patients who need them -- and if a treatment trial is given in the absence of a diagnosis, it should last no longer than a month," Hassall advised.