Proton pump inhibition. An effective, safe approach to GERD management

Prescribed worldwide to treat gastroesophageal reflux disease (GERD), the proton pump inhibitors (PPIs) not only relieve acid reflux-related symptoms more rapidly than standard-dose or high-dose histamine2 receptor antagonists but also accelerate the rate of esophageal healing. Five PPIs--omeprazole, esomeprazole, lansoprazole, rabeprazole, and pantoprazole--are currently labeled by the Food and Drug Administration. These agents share a common mechanism of action and rarely exhibit clinically important interactions with other hepatically metabolized medications or pH-dependent drugs. Except for lingering concern about their long-term use in Helicobacter pylori-positive patients, the PPIs produce relatively few adverse effects when administered for the short or long term. Because primary care physicians are generally the first to treat patients with GERD, they may find it helpful to expand their knowledge of the pharmacologic effects of the PPIs. With an eye toward this end, Dr Berardi presents a cogent overview of PPI pharmacodynamics, pharmacokinetics, efficacy, drug interactions, and safety.