Fenomen nagle obustave terapije inhibitorima protonske pumpe
Sažetak
Inhibitori protonske pumpe (IPP) su najpotentniji lekovi za suprimiranje sekrecije želudačne kiseline. Primenjuju se u terapiji acido-peptičkih poremećaja, uključujući peptičku ulkusnu bolest, gastroezofagusnu refluksnu bolest, Zollinger Elissonov sindrom, infekciju izazvanu bakterijom Helicobacter pylori i profilaksi ulkusa. U farmakoterapiji ovih poremećaja u značajnoj meri su potisnuli upotrebu H2 blokatora, kao druge, starije grupe antisekretornih lekova.
Dugotrajna terapija IPP dovodi do umerene hipergastrinemije (pojačana sekrecija gastrina) u 20-25% bolesnika. Ova hipergastrinemija rezultira povratnom hipersekrecijom želudačne kiseline (rebound fenomen) kod 30-40% bolesnika, koji su naglo prekinuli IPP. Većina pacijenata koji su naglo prekinuli IPP ima simptome dispepsije i gastroezofagusnog refluksa, najčešće gorušicu i osećaj paljenja u jednjaku.
Zbog toga treba voditi računa o pravilnom prekidu upotrebe IPP i smanjiti dozu leka pre potpunog ukidanja. Može se preći na manje efikasan blokator kiseline (H2 blokator), obzirom da blokatori H2 receptora izazivaju manje izraženu hipergastrinemiju i hiperplaziju enterohromafin sličnih ćelija (ECL ćelija) u poredjenju sa IPP.
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