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Proton pump inhibitors (PPIs) are the most potent drugs to inhibit gastric acid secretion, being used in the treatment of most inflammatory conditions of the gastric mucosa. They are among the most prescribed and overprescribed medications worldwide; for example, in the United States, according to the National Health and Nutrition Examination Survey, they almost doubled their use in adults aged 40 years and older from 4.9 % to 8.3 % between 1999 and 2012. Although they are generally considered well tolerated, some epidemiological studies extracting information from large databases have reported a number of adverse effects associated with their prolonged use, including cognitive impairment, chronic kidney disease, myocardial infarction, stroke, bone fractures and even death, among others. The objective was to conduct a narrative review of the literature on the effects of chronic use of PPIs on cognitive impairment in older adults. Articles were reviewed based on a search in the PubMed, Scopus and SciELO databases using both English and Spanish keywords and related MeSH/DeCS terms. Neurological side effects induced by chronic PPI use may be indirectly related to secondary systemic disorders (magnesium and vitamin B12 deficiency) or to direct effects on neuronal functioning after passing through the blood-brain barrier. Although several neurobiological mechanisms by which PPIs could favor the development of dementia--which involve Tau protein function, beta-amyloid [ßA] accumulation and cobalamin deficiency, among others--have been described, most of the available clinical evidence has not shown a significant association between PPI use and the risk of dementia or cognitive impairment. To establish the adverse clinical effects of chronic PPI use more clearly, especially on brain functioning, well-designed cohort studies with large sample sizes and long follow-up periods, with a reliable method to adjust for standardized confounders, as well as subgroup analyses are needed. [ABSTRACT FROM AUTHOR]

Introduction: Upper gastrointestinal bleeding prophylaxis with omeprazole is a frequent practice in patients admitted to the ICU. Infectious complications related to this therapy are currently being investigated. Objective: to determine the frequency with which early omeprazole prophylaxis is used in patients admitted to the ICU and to describe its clinical outcomes. The secondary objective was to determine the risk factors associated with the most frequent stress ulcers. Methods: a retrospective, descriptive study was conducted in a sample of patients admitted to the ICU of Hospital Santo Tomás in 2019. Results: 114 patients were included, with a median age of 40 years (IQR, 28-58), male predominance (60.53%) and a median time in ICU of 12 days (IQR, 6-24). 111 patients (97.37%) received early prophylaxis with omeprazole. In the group that received early prophylaxis, upper gastrointestinal bleeding occurred in 2.70% of cases; 40 patients (36.04%) presented nosocomial pneumonia and 1 patient (0.90) presented Clostridium difficile infection. In the sample studied, 110 patients (96.49%) used mechanical ventilation; 85 patients (74.56%) presented shock and 44 patients (38.60%) developed acute kidney injury. Conclusions: Early prophylaxis with omeprazole is a common practice in patients admitted to ICU. Upper gastrointestinal bleeding occurred infrequently. One third of the patients who received this treatment presented nosocomial pneumonia, being Clostridium difficile infection a rare complication. The use of mechanical ventilation and shock were the most frequent risk factors for stress ulcers. [ABSTRACT FROM AUTHOR]

Erosive esophagitis secondary to radiotherapy is an unusual complication in the oncological treatment of thoracic tumors. This pathological entity is associated with multiple complications, which is a clinical challenge for health workers unfamiliar with the clinical manifestations. Clinical case: A 64-year-old woman with a 3-day clinical picture of chest pain radiating to the epigastrium with 10/10 intensity. On physical examination, she was tachycardic, hypotensive, and with intense pain in the upper hemiabdomen region; she had no signs of peritoneal irritation on deep palpation. Paraclinical tests showed no signs of local or disseminated infection, but endoscopy of the digestive tract reported post-radiation esophagitis. Discussion: Erosive esophagitis after radiotherapy occurs in less than 1 % of cases, and clinical manifestations such as dysphagia, odynophagia, and abdominal pain are common. Initial symptomatic management is preserved, with supportive measures such as intravenous hydration and proton pump inhibitors (PPIs). In case of intolerance to the oral route, therapy with nutritional support is indicated via nasogastric tube or gastrostomy in the most severe cases. [ABSTRACT FROM AUTHOR]

The stability of a lyophilized product is very sensitive to the effect of residual humidity, for that reason it is important not only to control it in every stage of the process of lyophilization, but also the preparation of the packaging material to use. The objective of the present work was to evaluate the influence of the treatment received by bromobutyl freeze drying closures on the residual moisture content of the lyophilized injectable omeprazole 40 mg. The three bromobutyl freeze-dried closures batches of 20 mm were tested, sterilized by moist heat and dried. The moisture content of three industrial batches of omeprazole was estimated using sterile and dried closures, for twelve months, by Karl Fischer technique, as well as the assay of the injectable by a chromatographic method. It were successfully demonstrated that the closure's weight increased, as a result from the humidity absorption associated to the sterilization process. The drying process of the closures decreased the initial moisture content. The industrial batches of the freeze-dried injectable omeprazole, by using sterile and dry bromobutyl closures, kept the moisture content within the established limit, for twelve months, as well as the assay, without risks for the quality of the final product. [ABSTRACT FROM AUTHOR]

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The increased incidence of esophageal adenocarcinomas is a complication of duodenal reflux oesophagitis. D-002 has an oesophageal-protective effect demonstrated in different experimental models of acute and chronic esophagitis. In order to evaluate the influence of D-002 in esophageal adenocarcinomas formation induced by experimental duodenal esophageal reflux (DER) in rats, male SD rats were used. The animals were divided into five experimental groups, one control without DER, and four with DER induction by surgical procedure and receiving treatment with D-002, indomethacin and omeprazol at doses of 2, 20 y 200 mg/Kg, respectively, over a period of 16 weeks. At the end of treatments, the esophagus macroscopically was evaluated and the ILE was determined. Subsequently, the esophageal tissue was preserved in formaldehyde for histological analysis. The results showed that D-002, indomethacin and omeprazole treatments, significantly reduced (40, 35 and 50%, respectively) ILE; therefore, there were no significant histologic changes compared to positive control (DER). We concluded that oral administration of D-002 may be used as long-term treatment of duodenal reflux esophagitis, although not reverse the esophageal histological changes induced by duodenal reflux. [ABSTRACT FROM AUTHOR]

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Introduction: Extensive use of proton pump inhibitors (PPI) can result in an increased risk of drug interactions. Aged polypharmacy patients are a source of particular concern. A systematic electronic prescription (EP) review allows detection of potential drug - drug interactions. Material and methods: Retrospective, transversal, observational study: review of e-prescription orders received during 2015 in our community pharmacy. Results: 1186 EP dispensed to 164 patients (age 65.7±17.2), 52 patients in 71-80 range. 11.0±5.6 medicines per patient. 27% IBP EP with no approved indication. 77% EP used as gastroprotective agent. As far as omeprazole is concerned, risk of negative outcomes associated with medication (NOM) detected in 29 patients (30%), 15 of them taking the drug without approved indication. Most prevalent comorbidities: hypertension (n=81), dyslipidemia (n=61) and diabetes (n=36). Drugs responsible for potential interaction: acenocoumarol, iron, cyanocobalamin, escitalopram, benzodiazepines and clopidogrel. Discussion: 80% of omeprazole EP were dispensed to patients aged 61-90. Coupled with multimorbidity and polypharmacy, the duration of the treatment exceeded directions for use in most of the cases. Chronification and increase of NOM may be due to lack of an appropriate patient follow-up procedure. Many of the drugs responsible for omeprazole interactions were prescribed to treat most prevalent health problems. Thus, risk of NOM does not appear to depend on PPI appropriate indication. Conclusions: EP review let us to assess the risk of suffering from a NOM. Reviewing pharmacokinetic PPI interaction profile allows to depict the basics for a later intervention. During EP review, safety and necessity NOMs were recorded in similar percentages. Most relevant interactions found for omeprazole occur during metabolism of the drugs. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease is one of the most common gastrointestinal disorders affecting approximately 40% of the population worldwide. D-002 (beeswax alcohols) and omeprazole (OMP) present protective effects on experimental esophagitis induced by reflux. In this study, the effect of combined therapy D-002 + OMP on acute gastroesophageal reflux (GER) induced-esophagitis was evaluated. Rats were randomized into 5 groups: a negative control and 4 GER groups: a positive control, one D-002 (10 mg / kg), one OMP (5 mg / kg) and one combination (D-002 + OMP). The administration of monotherapies reduced moderately (48.91%) and significantly the ELI, while the combined therapy had a marked (76.05%) and significant inhibition compared with the positive control and with both monotherapies, respectively. Both, D-002 and OMP as well as combined therapy produced significant reductions in the MDA concentration in esophageal tissue (77.85, 48.62 and 66.45% inhibition, respectively) compared with the positive control, whereas no additional benefit of the combination was obtained compared with D-002 and OMP monotherapies. D-002 did not produce significant changes in the volume and acidity of gastric juice (GJ). OMP and the combined therapy did not change the volume of the GJ, although both reduced markedly (71.39%, 58.26%, respectively) and significantly the GJ acidity. In conclusion, the administration with single oral doses of D-002, OMP and the combined therapy exhibited a protective effect on GER induced-esophagitis in rats, being evident an additional beneficious effect of the combined therapy. [ABSTRACT FROM AUTHOR]

Omeprazole is a powerful proton pump inhibitor used as antacid in daily practice. It acts joining membrane H+ enzyme / K+ ATPase inthe final stage of the secretory stimulation. The literature refers morphologic changes in the gastric mucosa with high doses over short periods of time in adult as well as in pediatric patients. OBJECTIVE: to describe the histologic and ultrastructural morphological findings that could arise in the gastric parietal cells of young animals treated with high doses of omeprazole. MATERIAL AND METHOD: fifteen mice males of the BAI B/cAnN strain, of 20 days of age and 15 g of average weight. Ten of them received intraperitoneally 0.3 ml of sodium omeprazole 40 mg in injectable solution (omeprazole Richet) at a dose of 160 mg/kg/ day for 3 days were used. The remaining 5 only received the diluent. Samples were processed for optical microscopy (Zeiss Primo star®) and transmission electron microscopy (JEM 1200 EX IIJEOL'®). RESULTS: no evidences of significative changes were found at the histologic study, whereas the ultrastructural examination showed parietal cells with expansions of the canaliculi and distortions of villi with multiple cytoplasmic microvesicles. Neither nuclear nor mitochondrial alterations were found. The ultrastructural examination allowed to recognize early and specific morphological alterations in the parietal cells when high doses of omeprazole were used in a short period of time. [ABSTRACT FROM AUTHOR]

Introduction: Omeprazole is one of the most prescribed drugs in the Spanish National Health System. Its safety profile is considered to be good, nevertheless there are different adverse reactions described in the summary of product characteristics, some of them, although somewhat rare or very rare, are considered serious. Clinical evidence and recent studies have shown a relationship between continued use of omeprazole and other adverse events. Objectives: To find out how much of the treated population exceeds the duration of treatment, as stated in the Summary of Product Characteristics, for the treatment of reflux esophagitis and what proportion of this population may present potential risk of suffering any adverse reaction in circumstances that they were detected Patients and methods: Multicenter observational study whose data collection was performed in 27 community pharmacies located in 24 towns in the province of Badajoz using a structured questionnaire with five questions related to the use of omeprazole. Results: 60% of the patients studied amply exceed the treatment time to treat gastroesophageal reflux according to the summary of product characteristics. The 39% was in elderly population. The 4.5% of elderly patients who taking omeprazole on high doses for a long period of time (over one year), circumstances that make them more vulnerable to suffer any adverse reactions described. [ABSTRACT FROM AUTHOR]

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: H2 blockers histamine and therapy of gastric acid suppression have often been prescribed in the hospital for prophylaxis of gastrointestinal bleeding (GI) by acute ulcers in critically ill patients and other diseases, but its accessibility, good tolerance and low side effects have contributed to the abuse in their use. Methods: In the period between: 1/October/2005 to 31/September/2006, reviewed the medical charts of patients hospitalized (observation and/or shock) of ER to the GH CMNR, who met selection criteria. Collecting the data in Offi ce Excel program and analyzed using SPSS 14 (2005), the t Student Test and Kruskal Wallis test was used for statistical analysis with p:≥ 0.05 as signifi cant. Results: There were 148 women and 106 men (58.26%, 41.73%), with mean age 75 (range 17-105 years). Indicating frequent diagnoses were: gastropathy, infections, and surgical conditions. On admission 13.77% of patients were treated before and during your stay treatment was administered inhibitor of gastric suppression but inappropriately in 86.22% (p≥ 0.001). Most misused drugs were ranitidine, omeprazole and pantoprazole (p≥ 0.001) 82.20, 6.20 and 0.39% respectively. Conclusions: We found that treatment was indicated, but no basis in national or international guidelines, revealing that medical personnel requires updating the application of this treatment, as used improperly. The establishment of treatment guidelines in the ED to avoid the overuse of treatments without leaving patients unprotected at the time warrant. [ABSTRACT FROM AUTHOR]

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Copyright of Investigaciones ANDINA is the property of Fundacion Universitaria del Area Andina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

For this article efficacy and safety of the proton pump inhibitors (PPIs) omeprazole, lansoprazole, pantoprazole, and rabeprazole in the management of clorhidric acid-related diseases were compared. Clinical trials and review articles retrieved from a search from 1990 to the present that discussed the pharmacology, pharmacokinetics, efficacy, and safety of PPIs in the management of clorhidric acid-related diseases were reviewed. PPIs are substituted benzimidazoles that inhibit gastric acid secretion by covalently binding to the proton pump (H+/K+ ATPase). All undergo extensive hepatic metabolism and conjugation. The four agents differ in their metabolism by effects on specific hepatic enzymes and thus in their ability to interact with other medications. PPIs are important agents used for eradicating Helicobacter pylori, in treating peptic ulcer disease, gastroesophageal reflux disease, Zollinger-Ellison syndrome, and upper gastrointestinal bleeding and for preventing acid aspiration. Short-term side effects ol the four agents are similar. The long term safety of pantoprazole and rabeprazole appears to be similar to that of omeptazole and lansoptazole. Based on superior efficacy profiles, PPIs are the drugs of choice in managing patients with peptic ulcer disease, complete eradication of Helicobacter pylori, gastrointestinal bleeding, gastroesophageal reflux disease, and Zollinger-Ellison syndrome. The decision to select one PPI versus another is most likely to be based on the agents' acquisition costs, formulations, and overall safety profiles. [ABSTRACT FROM AUTHOR]