Differentiated approach to the choice of PPI in a patient with GERD in the practice of an outpatient (with a clinical case)
https://doi.org/10.21518/2079-701X-2020-21-118-125
Abstract
Gastroesophageal reflux disease (GERD) is a widespread disease. Despite the fact that different approaches to the treatment and prevention of recurrence of this disease have been developed, the number of patients with GERD, including refractory form of GERD, is only increasing. To date, well studied and described the possible links of the pathogenesis of this disease, which predetermine certain approaches to the treatment of various variants of GERD. Effective drug therapy of GERD includes the appointment of proton pump inhibitors (PPI). However, doctors are often faced with the problem of ineffective use of PPI in patients with GERD or with the so-called refractory form of GERD. The reasons for the ineffectiveness of therapy of PPI can be associated not only with the pathogenetic features of GERD and therapy, but also with the patient himself. Daily pH monitoring allows to determine the cause of the ineffectiveness of the treatment of PPI if the patient complies with all prescriptions. With ineffective acid suppression in the stomach, it is necessary to increase the dose of PPI or replace it. It is important to prescribe both effective and safe means of correcting the symptoms of GERD, and also take into account the possibility of long-term maintenance of remission when using them. These requirements are met by PPI, created in the form of enantiomers, having an improved pharmacokinetic profile. An example of this differentiated approach is dexlansoprazole, a law-converting monoisomer of lansoprazole with double release technology and the ability to maintain the antisecretory effect for a long time, which appeared relatively recently on the Russian pharmaceutical market. The use of this drug is presented in a clinical case.
About the Authors
I. G. Pakhomova
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Associate Professor of the Department of Internal Diseases, Associate Professor of the Department of Propaedeutics and Nursing,
2, Akkuratov St., St Petersburg, 197341
G. Yu. Knorring
Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Associate Professor of the Department of Therapy, Clinical Pharmacology and Emergency Medicine,
20, Bldg. 1, Delegatskaya St., Moscow, 127473
T. N. Kochegura
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Dr. of Sci. (Med.)., Associate Professor of the Department of Propaedeutics and Nursing,
2, Akkuratov St., St Petersburg, 197341
E. Yu. Pavlova
North-Western State Medical University named after I.I. Mechnikov
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Assistant Professor of the Department of Propaedeutics of Internal Diseases, Gastroenterology and Dietology named after S. M. Ryss,
41, Kirochnaya St., St Petersburg, 191015
References
1. El-Serag H.B., Sweet S., Winchester C.C., Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63(6):871–880. doi: 10.1136/gutjnl-2012-304269.
2. Lazebnik L.B., Masharova A.A., Bordin D.S., Vasilev Yu.V., Tkachenko E.I., Abdulkhakov R.A. et al. Multicentre study on the «Epidemiology of gastroesophageal reflux disease in Russia» (MEGRE): first results. Ehksperimentalnaya i klinicheskaya gastroehnterologiya = Experimental and Clinical Gastroenterology. 2009;(6):4–12. (In Russ.) Available at: https://elibrary.ru/item.asp?id=15234959.
3. Roman S., Gyawali C.P., Savarino E., Yadlapati R., Zerbib F., Wu J. et al. Ambulatory reflux monitoring for diagnosis of gastroesophageal reflux disease: update of the Porto consensus and recommendations from an international consensus group. Neurogastroenterol Motil. 2017;29(10):1–15. doi: 10.1111/nmo.13067.
4. Gyawali C.P., Kahrilas P.J., Savarino E., Zerbib F., Mion F., Smout A. et al. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018;67(7):1351–1362. doi: 10.1136/gutjnl-2017-314722.
5. Patel A., Sayuk G.S., Gyawali C.P. Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2015;13(5):884–891. doi: 10.1016/j.cgh.2014.08.029.
6. Kushnir V.M., Sathyamurthy A., Drapekin J., Gaddam S., Sayuk G.S., Gyawali C.P. Assessment of concordance of symptom reflux association tests in ambulatory pH monitoring. Aliment Pharmacol Ther. 2012;35(9):1080–1087. doi: 10.1111/j.1365-2036.2012.05066.x.
7. Frazzoni M., Savarino E., de Bortoli N., Martinucci I., Furnari M., Frazzoni L. et al. Analyses of the post-reflux swallow-induced peristaltic wave index and nocturnal baseline impedance parameters increase the diagnostic yield of impedance-pH monitoring of patients with reflux disease. Clin Gastroenterol Hepatol. 2016;14(1):40–46. doi: 10.1016/j.cgh.2015.06.026.
8. Frazzoni L., Frazzoni M., de Bortoli N., Tolone S., Martinucci I., Fuccio L. et al. Critical appraisal of Rome IV criteria: hypersensitive esophagus does belong to gastroesophageal reflux disease spectrum. Ann Gastroenterol. 2018;31(1):1–7. doi: 10.20524/aog.2017.0199.
9. Bordin D.S. Diagnostic and treatment algorithm for gastroesophageal reflux disease. Ehksperimentalnaya i klinicheskaya gastroehnterologiya = Experimental and Clinical Gastroenterology. 2011;(8):55–58. (In Russ.) Available at: https://cyberleninka.ru/article/n/algoritm-diagnostiki-i-lecheniya-gastroezofagealnoy-reflyuksnoy-bolezni/viewer.
10. Ivashkin V.T., Mayev I.V., Trukhmanov A.S., Baranskaya Y.K., Dronova О.B., Zayratyants О.V. et al. Diagnostics and treatment of gastroesophageal reflux disease: clinical guidelines of the Russian gastroenterological Association. Rossiyskiy zhurnal gastroehnterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Сoloproctology. 2017;27(4):75–95. doi: 10.22416/1382-4376-2017-27- 4-75-95.
11. Beaumont H., Bennink R.J., de Jong J., Boeckxstaens G.E. The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD. Gut. 2010;59(4):441–451. doi: 10.1136/gut.2009.178061.
12. Katz P.O., Gerson L.B., Vela M.F. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308–328. doi: 10.1038/ajg.2012.444.
13. Fass R., Inadomi J., Han C., Mody R., O’Neil J., Perez C.M. Maintenance of heartburn relief after step-down from twice-daily proton pump inhibitor to once-daily dexlansoprazole modified release. Clin Gastroenterol Hepatol. 2012;10(3):247–253. doi: 10.1016/j.cgh.2011.11.021.
14. Gunaratnam N.T., Jessup T.P., Inadomi J., Lascewski D.P. Sub-optimal proton pump inhibitor dosing is prevalent in patients with poorly controlled gastrooesophageal reflux disease. Aliment Pharmacol Ther. 2006;23(10):1473–1477. doi: 10.1111/j.1365-2036.2006.02911.x.
15. Trukhmanov A.S., Storonova O.A., Ivashkin V.T. Clinical impact of 24-hour pH-metry in esophageal and stomach diseases diagnostics and pharmacological drugs efficacy testing. Rossiyskiy zhurnal gastroehnterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Сoloproctology. 2016;26(6):55–68. (In Russ.) doi: 10.22416/1382-4376-2016-26-6-55-68.
16. Cicala M., Emerenziani S., Guarino M.P., Ribolsi M. Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease. World J Gastroenterol. 2013;19(39):6529–6535. doi: 10.3748/wjg.v19. i39.6529.
17. Evsyutina Yu.V., Trukhmanov A.S. Algorithm for the management of patients with refractory GERD. RMZh = RMJ. 2015;(28):1682–1683. (In Russ.) Available at: https://www.rmj.ru/articles/gastroenterologiya/Algoritm_vedeniya_pacientov_s_refrakternoyformoy_GERB.
18. Peura D.A., Pilmer B., Hunt B., Mody R., Perez M.C. The effects of increasing body mass index on heartburn severity, frequency and response to treatment with dexlansoprazole or lansoprazole. Aliment Pharmacol Ther. 2013;37(8):810–818. doi: 10.1111/apt.12270.
19. Kukulka M., Eisenberg С., Nudurupati S. Comparator pH study to evaluate the single-dose pharmacodynamics of dual delayed-release dexlansoprazole 60 mg and delayedrelease esomeprazole 40 mg. Clin Exp Gastroenterol. 2011;4:213–220. doi: 10.2147/CEG.S24063.
20. Shin J.M., Kim N. Pharmacokinetics and Pharmacodynamics of the Proton Pump Inhibitors. J Neurogastroenterol Motil. 2013;19(1):25–35. doi: 10.5056/jnm.2013.19.1.25.
21. Fass R., Johnson D.A., Orr W.C., Han C., Mody R., Stern K.N. et al. The Effect of Dexlansoprazole MR on Nocturnal Heartburn and GERD-Related Sleep Disturbances in Patients With Symptomatic GERD. Am J Gastroenterol. 2011;106(3):421–431. doi: 10.1038/ajg.2010.458.
22. Singh M., Lee J., Gupta N., Gaddam S., Smith B.K., Wani S.B. et al. Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial. Obesity (Silver Spring). 2013;21(2):284–290. doi: 10.1002/oby.20279.
23. El-Serag H.B., Graham D.Y., Satia J.A., Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100(6):1243–1250. doi: 10.1111/j.1572-0241.2005.41703.x.
24. Hampel H., Abraham N.S., El-Serag H.B. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143(3):199–211. doi: 10.7326/0003-4819-143-3-200508020-00006.
Review
For citations:
Pakhomova IG, Knorring GY, Kochegura TN, Pavlova EY. Differentiated approach to the choice of PPI in a patient with GERD in the practice of an outpatient (with a clinical case). Meditsinskiy sovet = Medical Council. 2020;(21):118-125. (In Russ.) https://doi.org/10.21518/2079-701X-2020-21-118-125
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