Virtually every life form relies upon a dynamic system of protons (positively charged particles) to transfer energy through the membranes that ordinarily act as barriers to physical passage. These proton "gradients" are actually pumped across membranes by special protein formations aptly known as "proton pumps." Unfortunately for patients suffering from Gastroesophageal Reflux Disease (GERD), several proton pumps around the stomach function as stimulants to the production of gastric acid.
Prescription medications known as proton pump inhibitors (PPIs) are widely prescribed to obstruct the action of these pumps, affording a great measure of relief from the painful symptoms of GERD. Some PPIs are used to promote healing of erosive esophagitis, or used with antibiotics in treating certain duodenal ulcers.
The first approved PPI in the US was omeprazole, introduced in 1989. Since then, lansoprazole, rabeprazole, pantoprazole and esomeprazole have been added to the PPI family. PPIs inhibit the proton flow by binding to the enzyme on the surface of the cells of the stomach wall. When the proton pump is thus blocked, the stomach lining secretes up to 90 percent less hydrochloric acid.
PPIs are also effective when used in combination with antibiotics sich as amoxycillin and clarithromycin to eliminate a bacterial infection of the stomach known as H. pylori infection, a leading cause of chronic gastric ulcers.
PPIs are available as tablets, capsules, powder, or injections. The treatment is usually continued for at least 1-2 months.
Advantages of PPIs
Only PPIs block all three known pathways of stomach acid stimulation. In contrast, acid suppressors block only one pathway, while antacids neutralize acid only after the stomach has produced it.
Diarrhea, abdominal pain, flatulence, gastritis, nausea, or headache have been reported as side effects. Patients who have liver or kidney disorders, or are pregnant or breastfeeding, may encounter serious side-effects and should consult carefully with their physician.
Studies have shown that PPIs are highly effective in healing severe GERD and in long-term therapy for symptom control and ulcer prevention.
Last updated: 04-Apr-03