جستجوی مقالات مرتبط با کلیدواژه « Proton pump inhibitors » در نشریات گروه « پزشکی »

Proton pump inhibitors (PPI) are a commonly prescribed medication, but recent evidence suggests that their long-term use may lead to several adverse events. To address this issue, our study aims to assess patient awareness and pharmacist practices in educating patients about the potential risks associated with prolonged PPI use.

Two questionnaires were developed by researchers and administered in the United Arab Emirates from June to August 2021 to gather insights from patients and pharmacists about the use of PPIs, their knowledge of potential side effects, and their experiences and attitudes toward receiving education about PPI side effects. The patients' knowledge was evaluated based on their cumulative correct answers to questions related to PPI’s long-term adverse effects including increased fracture risk and hypocalcemia, vitamin B12 deficiency, hypomagnesemia, and the caution of abrupt withdrawal. All statistical analyses were conducted using SPSS 25.0 software.

Overall, 348 participants with a median age of 40 years participated in the survey, among them, 91 (26.14%) used various forms of PPI with 38% of users taking PPI as over-the-counter drugs. Patients had low knowledge about PPI side effects and their proper discontinuation with a median knowledge score of 0 (Interquartile range: 0-2) and only 22.2% of patients were familiar with at least three out of five asked harms. Those with lower knowledge were more likely to be Emirati compared to other nations (p=0.004) and aged over 30 years compared to their younger counterparts (p = 0.016). Few patients have obtained the relevant information from their physicians (25%) or pharmacists (7%). Inquiring 136 pharmacists, it was shown that the most common education was concerning vitamin B12 deficiency (62.5%) followed by fracture risk (58.09%) yet less than half (48%) of pharmacists instructed patients about the potential risk of hypomagnesemia. Almost all pharmacists (99%) agreed that there is a requirement for additional education on the possible harmful consequences of PPIs.

The present study has established that a considerable proportion of PPI users in the UAE lack the necessary awareness about the potential adverse effects of PPI despite their extensive use in this country. The current pharmacist practice is inefficient for inculcating the potential harms of chronic PPI use and they are required to optimize their efforts to educate patients and bridge the knowledge gaps. 

Proton Pump Inhibitors (PPIs) are often prescribed inappropriately among hospitalized patients and same is often continued even after their discharge from the hospital. The inappropriate use of PPIs leads to an increased risk of adverse effects, drug interaction, and unnecessary hospital expenditure for such patients. Aim of this study was to determine the appropriateness of PPIs use among hospitalized patients.

A cross sectional observational study was conducted on hospitalized patients in a tertiary care hospital in Northern India. The clinical records of adult patients hospitalized during April- May 2022 were assessed for the prescribing pattern and appropriateness of PPI use as per the National Institute of Health and Care Excellence (NICE) guidelines.

A total of 192 patient’s records were included in this study with the mean age 57 years and 61% of the study participants were males. Overall, 72% (138) of the study participants were prescribed PPIs by intravenous route and only in 28% (54) cases an oral route was preferred. Pantoprazole was the most commonly prescribed PPI in 112 (58%) patients and it was administered by intravenous route among 87 patients (78%) and by oral route in 25 (22%) patients. PPI use was appropriate in 54% of the cases and they were most commonly prescribed for ulcer prophylaxis. This study identified higher use of PPIs was seen in low risk patients for longer duration than indicated.

PPIs are being prescribed inappropriately among hospitalized patient unrelated to their widely accepted clinical indications and are often continued unnecessarily once patient is discharged. These results suggest the need of regular audits on use of PPIs clubbed with educational initiatives to promote rational use of PPIs among hospitalized patients.

Investigation of Candida colonization of the esophagus and gastric mucosa in patients taking proton pump inhibitors in comparison to those taking histamine-2 receptor antagonists.

Candida species are normal flora of alimentary tract can cause infection of the esophagus and gastro-intestinal tract in immunocompromised patients. Consumption of proton pump inhibitors, and histamine-2 receptor antagonists have shown to alter the gastric pH which may predispose to floral transmission and colonization of the esophagus and stomach. Patients and

Two hundred and forty-five clinical specimens were obtained from 91 patients underwent endoscopy from September 2019 to February 2020. Direct microscopy with KOH 10% and subculture on sabouraud dextrose agar containing chloramphenicol used as primary screening. PCR with ITS primers was performed to amplify ITS1-5.8SrDNA-ITS2 region and MspI restriction enzyme used for RFLP to identify clinical isolates.

Seventy cultures out of 245 specimens were positive for Candida colonization (28.5%). Colonization of Candida species in gastric acid and gastric tissue biopsies of patients who took PPIs and H2 blockers was significantly higher than those were in control group (p = 0.001). The use of ranitidine, pantoprazole and omeprazole increased the risk of gastric candidiasis by 10.60, 9.20, and 12.99 times, respectively (p < 0.05).

The use of PPIs and H2 blockers, ageing, and consumption of vegetables were main risk factors for gastric infection in the present survey, and some other variables such as Candida species, cigarette smoking, drinking alcohol, etc. were not implicated in the development of gastroesophageal lesions. We need further investigations to know how these predisposing factors change the host defenses mechanisms and increase colonization of fungi at mucosal surfaces.

There is limited and conflicting evidence on the association between proton pump inhibitors (PPIs) and myocardial infarction (MI). This study aims to examine the occurrence of MI associated with PPI use from the Food and Drug Administration (FDA) Adverse Event Reporting System database.

This is a cross‑sectional study using data from the FDA dated from December 2013 to April 2018. Standard descriptive statistics were used to describe demographic information. Logistic regression analyses were performed to investigate the association between the independent variables and MI.

Among the 52,443 individuals who were taking a PPI and experienced an adverse event which was registered on the FDA database, 726 (1.38%) experienced MI. Of all the PPIs, esomeprazole had the largest proportion of users experiencing MI (1.81%). Compared to other PPIs, esomeprazole was associated with a significantly higher rate of MI (odds ratio [OR] =1.53, P < 0.001), whereas lansoprazole was associated with a lower rate of MI (OR = 0.74, P = 0.03).

Among the PPIs, esomeprazole appeared to have the highest risk of MI. Although the observed associations do not infer causality, this study highlighted a need for further studies to determine if a PPI, especially esomeprazole, can indeed cause MI.

ntroduction: Proton pump inhibitors can influence glucose-insulin homeostasis by elevating plasma gastrin.Considering the few clinical trials and contradictory results of previous studies, we aimed to evaluate the effect ofomeprazole, a proton pump inhibitor, on glucose-insulin homeostasis in patients with type 2 diabetes mellitus(T2DM).

In this before-after clinical trial, 40 patients with T2DM received omeprazoletreatment for 12 weeks. Patients were asked to continue their diet, lifestyle, and physical activity throughoutthe study period. Glycosylated hemoglobin (HbA1c), fasting plasma sugar (FBS), insulin level, C-peptide and 2hours post prandial blood sugar (2hppBS) were measured at baseline and after 12 weeks. Homeostatic modelassessment of Insulin resistance (HOMA-IR) and homeostatic model assessment ofβ-cell dysfunction (HOMA-B) indices were also calculated at baseline and after 12 weeks of omeprazole administration.

After 12weeks of omeprazole administration, there was a clear decrease in the mean HbA1C before (8.11±0.96) and after(7.13±0.68) the treatment (P<0.001). Similarly, a decrease in mean FBS and 2HPPBS before and after treatmentwas observed, which was statistically significant for FBS (P=0.01) but not for 2HPPBS (P=0.1). There was a clearincrease in the level of Insulin (P=0.001) and C-peptide (P=0.003). The mean activity index of HOMA-B beforeand after receiving omeprazole was 54.41±27.06 and 79.24±45.32, respectively (P=0.007). Also, HOMA-IR indexwas 5 before, and 6 after receiving omeprazole (P=0.001).

Administration of omeprazole, increasesinsulin levels and decreases the levels of HbA1c, FBS, thus improving glycemic status and can be combined withother drugs used to manage DM, especially in patients with gastrointestinal problems; but more studies areneeded.

Internal reference pricing (IRP) is one of the pharmaceutical pricing approaches, which is widely favored by health policymakers in different countries as a cost-containment tool for managing medicine expenditure. Evidence related to the implementation of this method confirms its usefulness in reducing pharmaceutical costs. Accordingly, the purpose of this study was to calculate potential changes in pharmaceutical expenditure using the IRP method for products belonging to three pharmaceutical categories in the pharmaceutical system of Iran.

This routine data study assessed the potential effect of IRP in three pharmaceutical categories including statins, non-steroidal anti-inflammatory drugs, and proton pump inhibitors (PPIs). Two scenarios for reference groups (levels 4 and 5 of the ATC code) and four scenarios for the reference price (i.e., the minimum, median, mean, and the mean of three minimum prices in the reference group) were considered in this regard, and the price and sales data source was the report published by the Iranian Food and Drug Administration. Then, cost changes were calculated with each hypothetical scenario. It was assumed that other intervening factors remain unchanged, including consumers and prescribers’ behavior.

Based on the results, the two largest potential saving effects belonged to the minimum price scenario and the mean of the scenario of the three minimum prices, respectively. However, the results showed that the consequence of using a price scenario other than the minimum price as the reference price is highly related to the details of the distribution of prices in the related reference group. In addition, appropriate decisions regarding outlier products (e.g., imported products) might have extremely important effects on the result, especially for the mean price scenario. The minimum price scenario concomitant with a premium for superior products can also be considered, but part of it is outside the scope of this study and requires independent research.

Thus if an appropriate scenario is selected for the reference price and group, the IRP method has the potential to reduce the costs of medicines. Therefore, pharmaceutical policymakers must pay enough attention to the details of planning this system and the needed procedure for updating the details of this system.

Proton pump inhibitors (PPIs) are one of the highly prescribed or over-the-counter available medications among Iranians, mainly to treat conditions such as helicobacter pylori infection, gastroesophageal reflux disease or frequent heartburn. In recent years, several reports have shown potential adverse effects of PPI administration among which cardiovascular adverse events, myocardial infarction and chronic kidney disease are considered as the greatest risks. Recent addition of proton pump inhibitors to the list of medications on Beers Criteria of Potentially Inappropriate Drugs has arisen significant concerns about their safety. This review aims at providing an up-to date overview of PPIs indications and their pharmacogenomics and pharmacokinetics in Iranian population. The focus of this review is on PPIs regimens in Iranian population and then it is compared with the reported studies performed on other ethnic groups around the world. An extensive review of the literature was carried out and data under various sections were identified using a computerized literature search via Pubmed, Web of Science, Google Scholar and some local search engines. All abstracts and full text articles were examined and most relevant papers were selected for inclusion in this review. Also several expert internalists were interviewed for their clinical experiences in this field.

The purpose of this study was to investigate and predict ventilator-associated pneumonia (VAP) in the two groups of patients who received either proton pump inhibitors (Pantoprazole) or histamine H2 antagonist (Ranitidine).
Patients in ICU received Pantoprazole or Ranitidine as stress-related mucosal injury and GI bleeding prophylaxis. The incidence rate of VAP and GI bleeding was estimated in each group during ICU stay. Chi-Square and Multivariate Logistic Regression Test were used for data analysis. P.value less than 0.05 was considered significant. Data analysis was performed through SPSS version 19.0.
The incidence rate of VAP in the Ranitidine and Pantoprazole groups was 44.7% and 37.3% respectively (p=0.3). According to the multivariable logistic regression analysis, length of mechanical ventilation ≥ 4 days was a predictive factor for VAP only in the Pantoprazole group (OR: 1.8, 95% CI: 1.56-1.90, p=0.006). No relationship between GI bleeding incidence and stress ulcer prophylaxis was found (p=0.4). Kaplan-Meier curve showed no significant difference between the two groups of Ranitidine and Pantoprazole (p=0.4) in survival time according to the length of ICU stay.
According to the results, there was no difference between the two groups in terms of VAP, GI bleeding and stress ulcer. Due to the lower cost of Ranitidine, it may be a more appropriate choice for GI bleeding prophylaxis in ICU patients.

Gastroesophageal reflux disease (GERD) is one of the common gastrointestinal diseases with various side effects. Proton pump inhibitor (PPI) drugs are widely used for their treatment and long‑term ingestion, which results in an electrolyte imbalance. This study investigates the changes in serum magnesium, calcium, sodium, and potassium after long‑term use of omeprazole in children.

This cross‑sectional study was conducted in 2016–2017 on 97 children and adolescents, aged 1–15 years, with GERD, in Isfahan, Iran. Enrolled were patients visiting a referral pediatric gastroenterology clinic (Imam Hossein
and Amin Hospitals) examined by an academic pediatric gastroenterologist. Before and 4 weeks after omeprazole administration, clinical manifestations including lethargy, muscle spasm, dyspnea, nausea, vomiting, abnormal heartbeat and deep tendon reflexes, and Chvostek and Trousseau signs were recorded in a data‑gathering form. In addition, fasting serum magnesium, calcium, sodium, and potassium were measured.

The McNemar test results showed that omeprazole can reduce sodium, calcium, and magnesium levels statistically significantly (P < 0.05), but potassium levels do not have a meaningful reduction (P > 0.05).

Consumption  of omeprazole might cause asymptomatic hypomagnesemia, hypocalcemia, and hypernatremia in children. Such side effects should be considered in the follow‑up of children under treatment with this medication.

Proton pump inhibitors (PPIs) with lipophilic nature may interact with lipid components of H. pylori cell membrane, disrupting cell structure and viability. In this study, the effect of PPIs on fatty acid and cholesterol components of H. pylori cell membrane was assessed.

One H. pylori isolate was treated with 1X and 2X MICs (μg/mL) of lansoprazole (LPZ: 8 and 16) and pantoprazole (PAN: 128 and 256) in brain heart infusion broth plus serum. Treated H. pylori was cultured on brucella blood agar (BBA) and tetrazolium egg yolk agar (TEYA). Bacterial cells stained with Live/Dead kit were examined by fluorescent microscopy. Fatty acid and cholesterol contents of treated H. pylori were measured by gas chromatography.

PPI-treated H. pylori did not grow on BBA but grew on TEYA. Fluorescent microscopy showed H. pylori stained red. Analyses showed high frequency of saturated fatty acids, C14:0, C16:0 and C18:0. Among unsaturated fatty acids, C18:1 and C18:2c were increased, while five were eliminated and five were synthesized de novo. Cholesteryl-6-O-tetradecanoyl-α-D- glucopyranoside was detected as the only glycosylated cholesterol in treated H. pylori. Growth of PPI-treated H. pylori on cholesterol-rich TEYA showed that occurrence of cholesterol can reverse the growth inhibition by PPIs. Red- bacilli form of H. pylori showed dye entry through damaged cell membrane without lysis.

Incorporation of lipophilic PPI into H. pylori cell membrane disrupted lipids and inhibited growth. However, H. pylori adjusted the defected membrane by replacing the lipid components and resisted lysis.

Peptic ulcer disease is a common gastrointestinal disorder, the prevalence of which has reduced in recent years due to effective new treatments. Peptic ulcer perforation is an emergent life-threatening condition that causes pneumoperitoneum and septic shock. It often requires surgical procedures. We describe two cases of peptic ulcer perforation with only mild discomfort on the epigastric region since several months before. The patients were treated with a high dose proton pump inhibitor and conservative treatment without surgical procedures. Weekly follow up of the cases showed that the clinical condition of patients remained stable without any new signs and symptoms. This report shows that noninvasive treatment alone can be effective in some cases with mild symptoms.

Helicobacter pylori (HBP) is reported as one of the main causes of peptic ulcer disease (PUD) and gastric cancer in the world. The challenge for finding an optimal treatment regimen for HBP eradication is still a matter of concern. The aim of this study was to compare the HBP eradication rate as well as side effects between two 10-days treatments of the standard triple and sequential regimen. This study was performed on patients with dyspepsia and HBP positive. Patients were categorized in two treatment groups including; standard (Omeprazole, Amoxicillin, and Clarithromycin) and sequential treatment (Omeprazole, Amoxicillin, Clarithromycin, and Metronidazole). HBP eradication rate, side effects, and treatment costs were compared between two groups. One hundred thirty-two patients (58 males, 74 females) with a mean age of 42.7±14.2-year-old were studied in two groups of Standard Treatment (n=66) and Sequential Treatment (n=66). There were not any significant differences between two groups regarding baseline features. The overall rate of HBP eradication was estimated to be 79.5%. Although, there was not any significant difference between the observed side effects, the mean cost of treatment in standard was significantly lower than that in the sequential group (P=0.001). It seems that there are not any clinical differences between 10-day treatment plan of the standard triple and sequential therapy in the case of HBP eradication and side effects. However, the sequential treatment might be a better option as the economic point of view.

Anaphylaxis is a serious life-threatening allergic reaction. Any medication may potentially trigger anaphylaxis, but reaction to pantoprazole is rare. Our case is a 21 year-old girl with anaphylactic reaction to pantoprazole a short time after prescription.

In patients with cirrhosis use of proton pump inhibitors (PPIs) may increase the risk of infection including spontaneous bacterial peritonitis. Also, in some studies PPIs usage had significant relationship with the severity of cirrhosis and development of hepatocellular carcinoma. In recent studies the relationship between PPIs usage and hepatic encephalopathy had been considered. The aim of this study was to assess the relationship between PPIs and hepatic encephalopathy for investigating their effects in the treatment of patients with cirrhosis.
In this study, 61 patients with liver cirrhosis were evaluated. The patients were followed up in two groups: patients with hepatic encephalopathy and patients with other complications.
PPIs usage and also the type and dosage of these drugs were not statistically different between the two groups. The duration of PPIs usage in the patients with hepatic encephalopathy was 23 ± 5.72 months and in the second group was 13.04 ± 3.061 months (p = 0.039).
In patients with cirrhosis, PPIs consumption for a long period, increases the risk of hepatic encephalopathy.

Eosinophilic esophagitis (EoE) is a chronic immune condition affecting children and adults. Dysphagia and food impaction are the main symptoms; however, reflux-like symptoms may also be present. The diagnosis of EoE is made with endoscopic evaluation for dysphagia, and its definitive diagnosis requires biopsy confirmation. The criteria for active EoE are defined as the symptoms of esophageal dysfunction, eosinophilic tissue infiltration (eosinophil count of at least 15 eosinophils per high-power field), and exclusion of other possible causes of esophageal eosinophilia. EoE is more prevalent in patients suffering from atopic conditions; therefore, allergic conditions may play an important role in the development of the disease. However, the etiology and pathophysiology of the disease are not completely understood. Elimination diets are considered as the first-line therapy in children; nevertheless, this approach appears to be less effective in adults, who often require steroids. Despite medical treatments, EoE is complicated in some cases by esophageal stricture and stenosis that require additional endoscopic treatments.

Combination antiplatelet therapy is a classic treatment for percutaneous coronary intervention (PCI) but this therapy increases gastrointestinal bleeding (GIB). This study highlights the incidence of related risk factors of GIB and endoscopic findings in patients with GIB after PCI and combination antiplatelet therapy.
A standard check list was used to evaluate the significant risk factors of GIB and upper endoscopic findings in combination antiplatelet treated patients after PCI in the GI center of Rajai Hospital- Karaj, Iran. All statistical tests were performed using SPSS software version 22.0.
During a 12-month period, a total of 103 patients with a mean age of 63 years were included. 64 patients were admitted to hospital and 39 patients were visited in the GI clinic. 54.4 % of the patients were male. The patients’ symptoms were melena (82.5%), hematemesis (28.1%), and hematochezia 3.9%). 6.8% of the patients were admitted with severe GIB and unstable conditions. Findings of upper endoscopy (n=82) were duodenal ulcer (63.4%), gastric ulcer (37.8 %), hiatal hernia (23.2%), Mallory Weiss syndrome (13.4%), gastric tumor (3.7%), and esophageal hematoma (2.4%). Normal endoscopic finding was seen in 14.6% of the patients who had history of GIB. Rapid urease test was positive in 46.3% of the patients. 12.6% of the patients died during hospital admission.
The high prevalence of GIB risk factors were seen among combination antiplatelet treated patients. By identifying and control of such risk factors, GIB in patients receiving combination antiplatelet therapy can be minimized.