gastroesophageal reflux disease. “a prevalent and chronic condition in which reflux of the stomach...
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Gastroesophageal Reflux Disease
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“a prevalent and chronic condition in which reflux of the stomach contents into the oesophagus causes a range of troublesome symptoms (including heartburn, acid regurgitation and epigastric pain) and complications”
Gastroesophageal Reflux Disease (GERD)
GERD causes disruption of physical, social and emotional well-being, reflux oesophagitis, haemorrhage, stricture, Barrett’s oesophagus and adenocarcinoma of the distal oesophagus; Prevalence: 20% of USA adult population (Sonnenberg et al, 1999) and similar results in Europe (Nazi et al 2006).
Vakil et al. The Montreal definition and classification of
GERD: a global evidence-based consensus. Am J Gastroenterol. 2006
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Sintomatology
Typical symptoms:
heartburn regurgitation
Others symptoms:
chronic cough wheezing hoarseness chest pain
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Proton Pumps Inhibitors (PPIs)
it primary function is the inhibition of acid production in the final common metabolic pathway of gastric parietal cells;It has an anti-secretory
and anti-ulcer activities;It accelerates the
spontaneous healing of acetic acid-induced gastric ulcers;When combined with two
or three antibiotics, are used for the eradication of Helicobacter pylori (Hp).
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Proton Pumps Inhibitors (PPIs)
All PPIs dose-dependently inhibit gastric acid secretion and raise intragastric pH for 24–48 h;
Intragastric pH should be maintained above 3.5 to heal peptic ulcer and above 4 to heal gastroesophageal reflux disease. These findings suggest that therapeutic
efficacy depends on drug dose and dosing interval.
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Proton Pumps Inhibitors (PPIs)
The area under the plasma concentration-vs.-time curve (AUC) is closely related to the inhibition of
gastric secretion.
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Omeprazole (20 mg)
Omeprazole exerts a prolonged anti-secretory effect.
“Twice daily dosing of Omeprazole 20mg b.d. appears to be significantly more effective than Lanzoprazole 30mg b.d. in controlling gastric acidity.”
Katz PO, Hatlebakk JG, Castell DO.
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LANZOprazole (30 mg)
Headache Diarrhea Dizziness Nausea
Lanzoprazole tends to relief symptoms more rapidly than Omeprazole, although initial healing is similar;It is an important alternative to Omeprazole.
Side effects:
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RABEprazole (20 mg)
Rabeprazole can achieve more than 90% of eradication rates;It is as effective as Omeprazole and Lansoprazole when included as part of a triple-therapy regimen;Side effects: Diarrhea Headache Rhinitis Nausea Pharyngitis Abdominal pain.
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PANTOprazole (40 mg)
diarrhea headache stomach pain gas or bloating
Side effects:
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ESOMEprazole (40 mg)
Decreases the chance of getting an ulcer in people who are taking nonsteroidal anti-inflammatory medications (NSAIDs);Treats and prevents the return of stomach ulcers caused by a certain type of bacteria (H. pylori), with other medications;More including than pantoprazole ;Esomeprazole has more side effects than the others PPIs, and some of them are also much more serious.
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ESOMEprazole (40 mg)
headache diarrhea nausea gas stomach pain constipation dry mouth blisters or peeling skin hives rash itching
difficulty breathing or swallowing;
swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs;
hoarseness
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Aims
To compare efficacy and tolerability of five proton pump inhibitors (PPIs) commonly used in the long-term therapy of GERD, namely omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole; To determine which PPI is more effective in
enduring symptom relief, improving quality of life as well as in healing and preventing mucosal injury.
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Study design
Synthesis studies: Metanalysis study
Bibliographic databases:• Medline (http://www.nlm.nih.gov/medlineplus/)• Pubmed (http://www.ncbi.nlm.nih.gov/sites/entrez)• Embase(http://www.elsevier.com/wps/find/
bibliographicdatabasedescription.cws_home/523328/description#description)
• …
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Turma 161º Ano
Disciplina de IntroMed IFMUP
Ana LopesAndreia PintoCatarina MeloDiogo DiasIsabel SaavedraJoão MatiasMariana FerreiraMariana Mangas Paula Neves Rita Sapage Rui CoelhoTeresa Caridade Teresa Tavares
19 de Outubro de 2007