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首页> 外文期刊>Italian Journal of Medicine >In-hospital gastric protection with proton pump inhibitors: adverse effects beyond (over)utilization?
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In-hospital gastric protection with proton pump inhibitors: adverse effects beyond (over)utilization?

机译：用质子泵抑制剂在医院内进行胃保护：超出（过度）利用的不良影响？

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Background: Proton pump inhibitors (PPIs) have provided important benefits in the management of gastroesophageal reflux disease (GERD), peptic ulcer disease and in the prevention of non steroidal antiinflammatory drugs and aspirin-related ulcer complications. PPIs are also the most commonly used medications for stress ulcer prophylaxis, despite little evidence to support their use in non-intensive care unit. Discussion: Considering the widespread use of PPIs, these agents’ overall safety profile is unquestionable. However, there is growing evidence that PPIs use may be associated with an increased risk of enteric infections, pneumonia, hip fractures, vitamin B12 deficiency. Overall, until now, none of these adverse effects have discouraged the PPIs treatment. Recently attention has been placed on a more important potential adverse effect of PPIs, their interaction with clopidogrel to which they are associated for the prophylaxis of gastrointestinal bleeding. Preliminary results of laboratory tests suggest that omeprazole reduces clopidogrel’s antiplatelet effect. The interaction seems to involve the competitive inhibition of the CYP2C19 isoenzyme. The effect appears to be clinically important, as some retrospective studies have shown an increase in adverse cardiovascular outcomes when PPIs and clopidogrel are used concomitantly. Some studies indicate that pantoprazole and esomeprazole are not associated with impaired response to clopidogrel. However, the available data for PPIs other than omeprazole do not allow definitive conclusions to be drawn about whether is a class effect. Conclusions: Specifically designed and randomized clinical studies are needed to define the interaction between PPIs and clopidogrel. Moreover, alternative treatment strategies with histamine- 2 receptor antagonists that are not dependent on cytochrome p450 2C19 should be tested in future studies.
机译：背景：质子泵抑制剂（PPI）在管理胃食管反流病（GERD），消化性溃疡疾病以及预防非甾体类抗炎药和阿司匹林相关的溃疡并发症方面提供了重要的益处。尽管很少有证据支持PPI在非重症监护病房中的使用，但PPI还是预防压力性溃疡的最常用药物。讨论：考虑到PPI的广泛使用，这些代理商的整体安全状况是毋庸置疑的。但是，越来越多的证据表明，使用PPI可能会增加肠道感染，肺炎，髋部骨折，维生素B12缺乏症的风险。总体而言，到目前为止，这些不利影响均未阻止PPI的治疗。最近，人们已经将注意力集中在更重要的潜在PPI潜在不良反应上，即PPI与氯吡格雷的相互作用，与它们预防胃肠道出血有关。实验室测试的初步结果表明，奥美拉唑会降低氯吡格雷的抗血小板作用。相互作用似乎涉及CYP2C19同工酶的竞争性抑制。这种效果在临床上似乎很重要，因为一些回顾性研究表明，同时使用PPI和氯吡格雷可增加不良心血管预后。一些研究表明pan托拉唑和埃索美拉唑与氯吡格雷反应减弱无关。但是，除奥美拉唑以外的其他PPI的可用数据无法得出关于是否为类效应的明确结论。结论：需要专门设计和随机化的临床研究来定义PPI和氯吡格雷之间的相互作用。此外，在未来的研究中应测试不依赖于细胞色素p450 2C19的组胺2受体拮抗剂的替代治疗策略。

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