Esomeprazole induces upper gastrointestinal tract transmucosal permeability increase

Area of Science:

• Gastroenterology
• Pharmacology
• Drug Safety

Background:

• Proton pump inhibitors (PPIs) are widely prescribed for gastro-oesophageal reflux disease (GERD) and dyspepsia.
• Previous research indicated a transmucosal upper gastrointestinal (GI) leak in Barrett's oesophagus (BO) patients.
• PPIs are frequently used by patients with Barrett's oesophagus.

Purpose of the Study:

• To investigate the effect of the PPI esomeprazole on the upper GI tract's barrier function.
• To determine if esomeprazole influences upper GI permeability.

Main Methods:

• Utilized the sucrose permeability test (SPT) to evaluate upper GI leak.
• Assessed 37 GERD patients initiating esomeprazole and 25 healthy controls.

Main Results:

• Esomeprazole administration led to a significant, rapid transmucosal leak in the upper GI tract of new users.
• The induced GI leak was reversible within days of ceasing esomeprazole treatment.

Conclusions:

• This study provides the first patient-based evidence that PPIs impair upper GI barrier function.
• Potential implications include increased transmucosal passage of co-administered drugs and endogenous substances.
• The clinical significance of this PPI-induced GI leak warrants further investigation.