Proton Pump Inhibitors

1
Proton Pump Inhibitors

• Appropriate Use in General Practice

2
Life before PPIs

• The history of dyspepsia
• Surgery and diet
• Vagotomy/Pyloroplasty
• Steamed fish and milk puddings
• H2-receptor antagonists
• Tagamet SKF
• Zantac Glaxo

3
Proton Pump Inhibitors

• Losec (Omeprazole)(Astra)
• Zoton (Lansoprazole)(Wyeth)
• Pariet (Rabeprazole)(Janssen)
• Nexium (Esomeprazole)(Astra)

4
NICE Guidance

• Issued in 2000
• Targeted use to make best use of resources

5
Dyspeptic Symptoms

• Diagnosed or not?
• Non-ulcer Dyspepsia
• Peptic Ulceration
• GORD

6
Peptic Ulceration

• Helicobacter-related?
• ERADICATE
• NSAID-related?
• Co-Prescribe PPI if cannot stop NSAID

7
Gastro-Oesophageal Reflux

• Severe
• healing dose PPI until symptoms controlled
• maintenance dose to prevent recurrence
• Complicated
• stricture, ulcer, haemorrhage etc
• full dose maintained
• Mild
• alternative Rx antacid, alginate, H2RA

8
Non-ulcer Dyspepsia

• Use Acid Suppressor (H2RA) NOT PPI
• Step-up or Step-down

9
Investigation

• Over 55 ENDOSCOPY
• Alarm Symptoms ENDOSCOPY
• dysphagia
• anaemia
• progressive weight loss
• Under 45 NO INVESTIGATION
• 45-55 DEBATABLE