Potencijalni rizici farmakološki izazvane hipoklorhidrije

master's thesis

• Title (english): The potential risk of pharmacologically induced hypochlorhydria
• Author: Iva Canjuga
• Mentor: Neven Ljubičić (mentor)
• Committee member: Lucija Virović Jukić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Neven Ljubičić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Clinical Pharmacology and Toxicology

Abstract

Inhibitori protonske pumpe (IPP) trenutno su najdjelotvorniji lijekovi u regulaciji lučenja želučane kiseline. Postali su terapija izbora u liječenju gastroezofagealne refluksne bolesti, peptičkih ulkusa, Zollinger-Ellisonova sindroma (ZOS), funkcionalne dispepsije, lezija uzrokovanih nesteroidnim antireumaticima (NSAR), eradikacije Helicobacter pylori i ostalih hipersekretornih stanja. Na tržištu se nalazi pet lijekova iz ove skupine: omeprazol, esomeprazol, lansoprazol i rabeprazol za oralnu i pantoprazol za oralnu i intravensku upotrebu. Glavni mehanizam njihova djelovanja je inhibicija protonske pumpe parijetalnih stanica želuca i smanjenje stvaranja želučane kiseline. Visoka učinkovitost, jednostavna primjena, prihvatljiva cijena i rijetke nuspojave dovele su do pretjeranog propisivanja IPP-a u bolničkih i ambulantnih pacijenata. Zbog toga dolazi do povećane izloženosti pacijenata potencijalnim rizicima. Dugotrajna terapija IPP-ima uzrokuje hipoklorhidriju, hipergastrinemiju i proliferaciju parijetalnih stanica. Potencijanlo nepovoljno djelovanje može se odraziti na metabolizam vitamina B12, željeza i magnezija, regulaciju kalcija i nastanak osteoporotičnih fraktura, pojavnost enteralnih infekcija, posebice Clostridium difficile kolitisa i izvanbolničke pneumonije, promjenu sluznice želuca stvaranjem benignih polipa ili malignih promjena, nastanak demencije i pogoršanje bolesti srca i bubrega. Racionalnom primjenom IPP-a, kontrolom i evaluacijom stanja pacijenata te njihovom edukacijom moguće je smanjiti pojavnost rizika i stanja do kojih dovodi neprimjereno liječenje.

Abstract (english)

Proton pump inhibitors (PPI) are currently the most effective drugs regulating hydrochloric acid secretion. They have become the therapy of choice for a range of upper gastrointestinal tract disorders, including gastroesophageal reflux disease, peptic ulcer disease, Zollinger-Ellison syndrome (ZOS), functional dyspepsia, lesions caused by nonsteroidal anti-inflammatory drugs (NSAIDs), Helicobacter pylori eradication therapy and other hypersecretory conditions. There are five PPIs approved for use. While omeprazole, esomeprazole, lansoprazole and rabeprazole are available as oral formulations, pantoprazole is intended for oral and intravenous use. Their main mechanism of action is inhibition of parietal cells’ proton pump and suppression of hydrochloric acid secretion. Great effectiveness, simple use, acceptable costs and rare adverse effects have led to overutilization in hospital and ambulatory care. It increases the risk of some side effects. The long-term use of PPIs causes hypochlorhydria, hypergastrinemia and parietal cell proliferation. It may affect the metabolism of vitamin B12, iron and magnesium, absorption of calcium, increased risk of osteoporotic bone fracture, enteric infections including Clostridium difficile-associated diarrhea, community-acquired pneumonia, the transformation of the gastric mucous membrane, deterioration of dementia, heart and kidney disease. Reasonable approach to clinical indications and patients’ education can minimize the potential for adverseevents.

• Keywords: inhibitori protonske pumpe; hipoklorhidrija; rizici
• Keywords (english): proton pumpinhibitors; hypochlorhydria; risk
• Language: croatian
• URN:NBN: urn:nbn:hr:105:811186
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-10-30 08:42:32