Proton-pump inhibitors - up to date

Abstract

To date, five proton pump inhibitors (PPIs) are available: The first generation of PPIs includes omeprazole, lansoprazole and pantoprazole; the second generation is represented by rabeprazoleand esomeprazole which have several advantages overthe older agents, particularly in terms of rapid action and profound and consistent acid inhibition. The older PPIs, mainly omeprazole and lansoprazole are predominantly metabolised by CYP2C19, whereas pantoprazole and esomeprazole are metabolized also by other metabolic pathways and only to a lesser extent by CYP2C19. The PPIs have been developed and licensed in different dosages; omeprazole 20 mg, esomeprazole 40 mg, lansoprazole 30 mg, pantoprazole 40 mg and rabeprazole 20 mg. First generation of PPIs have comparable antisecretion efficacy which is influenced by enzymatic activity of CYP2C19. Currently, PPis are used in several indication of acid-related diseases. They have significant role in therapy of gastric and duodenal ulcers; gastro-oesophageal reflux disease; therapy and prophylaxis of NSAIDs gastropathy; co-therapy in eradication of Helicobacter pylori infection; therapy of functional dyspepsia and treatment and prophylaxis of recurrent non-variceal upper Gl bleeding. The safety profile of PPIs seems to be favourable, both in short-term and long-term use.