gastrointestinal disorders
Medications for the Treatment of Gastric Acidity
Proton Pump Inhibitors
These medications are potent inhibitors of H+,K+-ATPase. This enzyme, located in the apical secretory membrane of the parietal cell, plays a key role in the secretion of H+ (protons). These medications can completely inhibit acid secretion and have a long duration of action. They promote ulcer healing and are also key components ofH. pylorieradication regimens. Proton pump inhibitors have replaced H2 blockers in most clinical situations because of efficacy. Proton pump inhibitors includeesomeprazole,lansoprazole, andpantoprazole, these are available orally and IV, andomeprazoleandrabeprazole, available only orally in the United States (see table). Oral and IV doses are the same.Omeprazole,esomeprazole, andlansoprazoleare available without a prescription in the United States. 30 mg once a day is given for 4 weeks. Complicated Peptic Ulcer Disease (ie, multiple ulcers, bleeding ulcers, those Medication Medication Most Conditions, Including Gastritis, GERD, and Uncomplicated Duodenal Ulcers Most Conditions, Including Gastritis, GERD, and Uncomplicated Duodenal Ulcers Gastric Ulcers and Complicated Duodenal Ulcers Gastric Ulcers and Complicated Duodenal Ulcers Esomeprazole 40 mg once a day 40 mg 2 times a day Lansoprazole 30 mg once a day Pediatric dosages: <10 kg: 7.5 mg once a day 10–20 kg: 15 mg once a day ≥20 kg: 30 mg once a day* 30 mg 2 times a day — Omeprazole 20 mg once a day Pediatric dosage: 1 mg/kg/day in a single dose or divided 2 times a day* 40 mg once a day — Pantoprazole 40 mg once a day 40 mg 2 times a day Rabeprazole 20 mg once a day 20 mg 2 times a day * Representative dosages. Oral and IV doses are the same. Data are limited to the use of proton pump inhibitors in children. GERD = gastroesophageal reflux disease. Long-term proton pump inhibitor therapy produces elevated gastrin levels, which lead to enterochromaffin-like cell hyperplasia. However, there is no evidence of dysplasia or malignant transformation in patients receiving this treatment. Micronutrient deficiencies (eg, vitamin B12 and magnesium) have been reported in a small number of patients. The absolute excess risk is 0.3 to 0.4% per patient per year. Some studies suggest that the risk of enteric infections such asClostridioides difficilemay be higher in patients receiving long-term therapy, but other studies do not support this observation. The absolute excess risk varies from 0 to 0.09% per patient. Carefully conducted studies have shown no effect on bone health or the risk of dementia, Parkinson disease, heart disease, and pneumonia. 