What are proton pump inhibitors (PPIs), and how do they work (mechanism of action)?
Proton pump inhibitors (PPIs) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid. Acid is necessary for the formation of most ulcers in the esophagus, stomach, and duodenum, and the reduction of acid with PPIs prevents ulcers and allows any ulcers that exist in the esophagus, stomach, and duodenum to heal.
What diseaes or conditions do PPIs treat?
Proton pump inhibitors are used for the prevention and treatment of acid-related conditions such as:
- Esophageal duodenal and stomach ulcers
- NSAID-associated ulcer
- Gastroesophageal reflux disease (GERD)
- Zollinger-Ellison syndrome
They also are used in combination with antibiotics for eradicating Helicobacter pylori, a bacterium that together with acid causes ulcers of the stomach and duodenum.cs for eradicating H. pylori, a bacterium that together with acid causes ulcers of the stomach and duodenum.
Are there differences among proton pump inhibitors (PPIs)?
Proton pump inhibitors are very similar in action and there is no evidence that one is more effective than another. They differ in how they are broken-down by the liver and their drug interactions. The effects of some PPIs may last longer; therefore, they may be taken less frequently.
What are the side effects of proton pump inhibitors (PPIs)?
The most common side effects of proton pump inhibitors are:
- Abdominal pain
Nevertheless, proton pump inhibitors generally are well tolerated.
PPIs may increase the risk of Clostridium difficile infection of the colon. High doses and long-term use (1 year or longer) may increase the risk of osteoporosis-related fractures of the hip, wrist, or spine. Prolonged use also reduces absorption of vitamin B12 (cyanocobalamin).
Long-term use of PPIs has also been associated with low levels of magnesium (hypomagnesemia). Analysis of patients taking PPIs for long periods of time showed an increased risk of heart attacks.
Therefore, it is important to use the lowest doses and shortest duration of treatment necessary for the condition being treated.
Other serious side effects associate with PPIs include:
- Serious allergic reactions
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
- Reduced kidney function
- Reduced liver function
- Erythema multiforme