From the Guidelines
The recommended liquid proton pump inhibitors (PPIs) include esomeprazole oral suspension (20-40 mg twice daily) and rabeprazole oral suspension, as they are higher-potency PPIs that can be utilized twice daily for optimal outcomes, as suggested by the most recent evidence 1. When selecting a liquid PPI, it's essential to consider the patient's specific needs, such as difficulty swallowing pills, presence of feeding tubes, or age-related swallowing difficulties.
- The mechanism of action for all PPIs involves blocking the hydrogen-potassium ATPase enzyme system in gastric parietal cells, reducing acid production in the stomach, making them effective for treating conditions like gastroesophageal reflux disease (GERD), peptic ulcers, and erosive esophagitis.
- Dosing should be adjusted based on the specific condition being treated and patient factors such as age, weight, and renal function, with the goal of achieving the lowest effective dose to minimize potential side effects.
- It's crucial to note that the choice of PPI and dosing regimen should be guided by the most recent and highest-quality evidence, with consideration of factors such as potency, efficacy, and safety, as highlighted in the study published in the Annual Review of Medicine 1.
- In clinical practice, the use of liquid PPIs, such as esomeprazole and rabeprazole, can be tailored to individual patient needs, taking into account factors such as symptom severity, treatment response, and potential interactions with other medications, as discussed in the guidelines for the management of gastroesophageal reflux disease 1.
From the Research
Liquid Proton Pump Inhibitors
- The recommended liquid proton pump inhibitors (PPIs) include lansoprazole, omeprazole, pantoprazole, and rabeprazole 2, 3, 4.
- These PPIs are highly useful for the relief of symptoms and healing of gastroesophageal reflux disease, gastric and duodenal ulcer disease, eradication of Helicobacter pylori infection, prevention and treatment of nonsteroidal anti-inflammatory drug (NSAID)-associated damage, management of hypersecretory states such as Zollinger-Ellison syndrome, and care of patients with non-variceal upper gastrointestinal bleeding, or non-ulcer dyspepsia 2.
- The dosages of these PPIs vary, but they are often administered once daily to produce endoscopic evidence of healing in >90% of patients with duodenal ulcer after 4 weeks of treatment, in >90% of those with gastric ulcer after 6 weeks of treatment, and in >90% of those with ulcerative or erosive GERD after 8 weeks of treatment 4.
Comparison of PPIs
- Comparisons of the four different proton pump inhibitors show that they all have similar potency and efficacy 3.
- Rabeprazole displays a slightly more rapid onset of acid inhibition than the others, but the clinical advantage of this seems limited 3, 4.
- The S-isomer of omeprazole, esomeprazole, exhibits a somewhat higher potency than the other proton pump inhibitors, but reports supporting a clinical advantage of this property are not convincing 3.
Clinical Pharmacology
- PPIs have emerged as the treatment of choice for acid-related diseases, including gastroesophageal reflux disease (GERD) and peptic ulcer disease 4, 5.
- The mechanism of action of PPIs involves inhibition of the H-K-adenosine triphosphatase enzyme present in the parietal cells of the gastric mucosa 5.
- PPIs are the most potent inhibitors of gastric acid secretion available, and they effectively alleviate acid-peptic symptoms and facilitate healing of inflamed or ulcerated mucosa 5.