ppis lansoprazole dexlansoprazole revaprazan esomeprazole rabeprazole pantoprazole omeprazole vaezi gastroenterological gutjnl adma clopidogrel oesophageal sifo s11894 zollinger overgrowth dysbiosis gastro dyspepsia ppi bioavailable gastroesophageal freedberg reflux pylori 6817 empiric antiplatelet
the most effective inhibitor of human gastric acid secretion is
Proton - pump inhibitor - wikipedia Proton - pump inhibitor Jump to : navigation , search drug for reducing stomach acid <Th_colspan="2"> Proton - pump inhibitor <Td_colspan="2"> Drug class <Td_colspan="2"> General structure of a proton - pump inhibitor <Th_colspan="2"> Class identifiers Use Reduction of gastric acid production ATC code A02BC Mechanism of action Enzyme inhibitor Biological target H / K ATPase <Th_colspan="2"> Clinical data Drugs.com Drug Classes WebMD MedicineNet <Th_colspan="2"> External links MeSH D054328 <Td_colspan="2"> In Wikidata Proton - pump inhibitors ( PPIs ) are a group of drugs whose main action is a pronounced and long - lasting reduction of stomach acid production . Within the class of medications , there is no clear evidence that one agent works better than another . They are the most potent inhibitors of acid secretion available . This group of drugs followed and largely superseded another group of medications with similar effects , but a different mode of action , called H - receptor antagonists . PPIs are among the most widely sold drugs in the world , and the first one , omeprazole , is on the WHO Model List of Essential Medicines . The cost between different agents varies significantly . Contents ( hide ) 1 Medical uses 2 Adverse effects 2.1 Nutritional 2.2 Gastrointestinal 2.3 Cardiovascular 2.4 Other 3 Mechanism of action 4 Pharmacokinetics 5 Examples 6 History 7 Society and culture 7.1 Cost 7.2 Regulatory approval 8 References 9 External links Medical uses ( edit ) These drugs are used in the treatment of many conditions , such as : Dyspepsia Peptic ulcer disease including after endoscopic treatment for bleeding As part of Helicobacter pylori eradication therapy Gastroesophageal reflux disease ( GERD or GORD ) including symptomatic endoscopy - negative reflux disease and associated laryngopharyngeal reflux causing laryngitis and chronic cough Barrett 's esophagus Eosinophilic esophagitis Stress gastritis and ulcer prevention in critical care Gastrinomas and other conditions that cause hypersecretion of acid including Zollinger -- Ellison syndrome ( often 2 -- 3x the regular dose is required ) Specialty professional organizations recommend that people take the lowest effective PPI dose to achieve the desired therapeutic result when used to treat gastroesophageal reflux disease long - term . In the United States , the Food and Drug Administration has advised that no more than three 14 - day treatment courses should be used in one year . Despite their extensive use , the quality of the evidence supporting their use in some of these conditions is variable . The effectiveness of PPIs has not been demonstrated for every case . For example , although they reduce the incidence of esophageal adenocarcinoma in Barrett 's oesophagus , they do not change the length affected . Adverse effects ( edit ) In general , proton pump inhibitors are well tolerated , and the incidence of short - term adverse effects is relatively low . The range and occurrence of adverse effects are similar for all of the PPIs , though they have been reported more frequently with omeprazole . This may be due to its longer availability and , hence , clinical experience . Common adverse effects include headache , nausea , diarrhea , abdominal pain , fatigue , and dizziness . Infrequent adverse effects include rash , itch , flatulence , constipation , anxiety , and depression . Also infrequently , PPI use may be associated with occurrence of myopathies , including the serious reaction rhabdomyolysis . Long - term use of PPIs requires assessment of the balance of the benefits and risks of the therapy . Various adverse outcomes have been associated with long - term PPI use in several primary reports , but reviews assess the overall quality of evidence in these studies as `` low '' or `` very low '' . They describe inadequate evidence to establish causal relationships between PPI therapy and many of the proposed associations , due to study design and small estimates of effect size . Benefits outweigh risks when PPIs are used appropriately , but when used inappropriately , modest risks become important . They recommend that PPIs should be used at the lowest effective dose in people with a proven indication , but discourage dose escalation and continued chronic therapy in people unresponsive to initial empiric therapy . Nutritional ( edit ) Gastric acid is important for breakdown of food and release of micronutrients , and some studies have shown possibilities for interference with absorption of iron , calcium , magnesium , and vitamin B. With regard to iron and vitamin B , the data are weak and several confounding factors have been identified . Low levels of magnesium can be found in people on PPI therapy and these can be reversed when they are switched to H2 - receptor antagonist drugs . High dose and / or long - term use of PPIs carries a possible increased risk of bone fractures which was not found with short - term , low dose use ; the FDA included a warning regarding this on PPI drug labels in 2010 . Gastrointestinal ( edit ) Some studies have shown a correlation between use of PPIs and Clostridium difficile infections . While the data are contradictory and controversial , the FDA had sufficient concern to include a warning about this adverse effect on the label of PPI drugs . Concerns have also been raised about spontaneous bacterial peritonitis in older people taking PPIs and in people with irritable bowel syndrome taking PPIs ; both types of infections arise in these populations due to underlying conditions and it is not clear if this is a class effect of PPIs . PPIs may predispose an individual to developing small intestinal bacterial overgrowth or fungal overgrowth . Long - term use of PPIs is associated with the development of benign polyps from fundic glands ( which is distinct from fundic gland polyposis ) ; these polyps do not cause cancer and resolve when PPIs are discontinued . There is no association between PPI use and cancer or pre-cancer . There is concern that use of PPIs may mask gastric cancers or other serious gastric problems and physicians should be aware of this effect . PPI use has also been associated with the development of microscopic colitis . There is also evidence that PPI use alters the composition of the bacterial populations inhabiting the gut . Although the mechanisms by which PPIs cause these changes are yet to be determined they may have a role in the increased risk of bacterial infections with PPI use . Cardiovascular ( edit ) Associations of PPI use and cardiovascular events have also been widely studied but clear conclusions have not been made as these relative risks are confounded by other factors . PPIs are commonly used in cardiovascular patients for gastric protection when aspirin is given for its antiplatelet actions . An interaction between PPIs and the metabolism of the platelet inhibitor clopidogrel is known and this drug is also often used in patients with cardiac disease . One suggested mechanism for cardiovascular effects is because PPIs bind and inhibit dimethylargininase , the enzyme that degrades asymmetric dimethylarginine ( ADMA ) , resulting in higher ADMA levels and a decrease in bioavailable nitric oxide . Other ( edit ) Associations have been shown between PPI use and an increased risk of pneumonia , particularly in the 30 days after starting therapy , where it was found to be 50 % higher in community use . Other very weak associations of PPI use have been found , such as with chronic kidney disease and dementia . As these results were derived from observational studies , it remains uncertain whether such associations are causal relationships . Mechanism of action ( edit ) The activation of PPIs Micrograph of the gastric antrum showing G cell hyperplasia , a histomorphologic change seen with PPI use ( H&E stain ) Proton pump inhibitors act by irreversibly blocking the hydrogen / potassium adenosine triphosphatase enzyme system ( the H / K ATPase , or , more commonly , the gastric proton pump ) of the gastric parietal cells . The proton pump is the terminal stage in gastric acid secretion , being directly responsible for secreting H ions into the gastric lumen , making it an ideal target for inhibiting acid secretion . Targeting the terminal step in acid production , as well as the irreversible nature of the inhibition , results in a class of drugs that are significantly more effective than H antagonists and reduce gastric acid secretion by up to 99 % . Decreasing the acid in the stomach can aid the healing of duodenal ulcers and reduce the pain from indigestion and heartburn . However , stomach acids are needed to digest proteins , vitamin B , calcium , and other nutrients , and too little stomach acid causes the condition hypochlorhydria . The PPIs are given in an inactive form , which is neutrally charged ( lipophilic ) and readily crosses cell membranes into intracellular compartments ( like the parietal cell canaliculus ) with acidic environments . In an acid environment , the inactive drug is protonated and rearranges into its active form . As described above , the active form will covalently and irreversibly bind to the gastric proton pump , deactivating it . Pharmacokinetics ( edit ) The rate of omeprazole absorption is decreased by concomitant food intake . In addition , the absorption of lansoprazole and esomeprazole is decreased and delayed by food . It has been reported , however , that these pharmacokinetic effects have no significant impact on efficacy . PPIs have a half - life in human blood plasma of only 60 -- 90 minutes , but because they covalently bind to the pump , the half - life of their inhibition of gastric acid secretion lasts an estimated 24 hours . Dissociation of the inhibitory complex is probably due to the effect of the endogenous antioxidant glutathione which leads to the release of omeprazole sulfide and reactivation of the enzyme . Examples ( edit ) Medically used proton pump inhibitors : Omeprazole ( OTC in the USA ) Lansoprazole Dexlansoprazole Esomeprazole Pantoprazole Rabeprazole Ilaprazole ( not FDA approved as of May 2017 ) History ( edit ) See also : Discovery and development of proton pump inhibitors PPIs were developed in the 1980s with omeprazole being launched in 1988 . Most of these drugs are benzimidazole derivatives , related to omeprazole , but imidazopyridine derivatives such as tenatoprazole have also been developed . Potassium - competitive inhibitors such as revaprazan reversibly block the potassium - binding site of the proton pump , acting more quickly , but are not available in most countries . Society and culture ( edit ) Cost ( edit ) In British Columbia , Canada the cost of the PPIs varies significantly from 0.20 CAD to 2.38 CAD per dose while all agents in the class appear more or less equally effective . Regulatory approval ( edit ) A comparative table of FDA - approved indications for PPIs is shown below . Comparative indications Indication Omeprazole Esomeprazole Lansoprazole Dexlansoprazole Pantoprazole Rabeprazole Gastroesophageal reflux disease Erosive esophagitis - healing Yes Yes Yes Yes Yes Yes Erosive esophagitis - maintenance Yes Yes Yes Yes Yes Yes Nonerosive reflux disease Yes Yes Yes Yes No Yes Peptic ulcer disease Duodenal ulcer - healing Yes No Yes No No Yes Duodenal ulcer - maintenance No No Yes No No No Gastric ulcer - healing Yes No Yes No No No NSAID induced ulcer - healing No No Yes No No No NSAID induced ulcer - prophylaxis No Yes Yes No No No Zollinger - Ellison syndrome Yes Yes Yes No Yes Yes Treatment of Helicobacter pylori Dual therapy Yes No Yes No No No Triple therapy Yes Yes Yes No No Yes References ( edit ) ^ Jump up to : `` ( 99 ) Comparative effectiveness of proton pump inhibitors Therapeutics Initiative '' . 28 June 2016 . Retrieved 14 July 2016 . ^ Jump up to : Dean , Laura ( 1 October 2010 ) . `` Comparing Proton Pump Inhibitors '' . PubMed Health . Retrieved 16 July 2016 . ^ Jump up to : Sachs , G. ; Shin , J.M. ; Howden , C.W. ( 2006 ) . `` Review article : The clinical pharmacology of proton pump inhibitors '' . Alimentary Pharmacology and Therapeutics . 23 : 2 -- 8 . doi : 10.1111 / j. 1365 - 2036.2006. 02943. x . PMID 16700898 . Jump up ^ `` WHO Model List of EssentialMedicines '' ( PDF ) . World Health Organization . October 2013 . Retrieved 22 April 2014 . Jump up ^ Zajac , P ; Holbrook , A ; Super , ME ; Vogt , M ( March -- April 2013 ) . `` An overview : Current clinical guidelines for the evaluation , diagnosis , treatment , and management of dyspepsia '' . Osteopathic Family Physician. 5 ( 2 ) : 79 -- 85 . doi : 10.1016 / j. osfp. 2012.10. 005 . Jump up ^ Wang WH , Huang JQ , Zheng GF , Xia HH , Wong WM , Liu XG , et al. ( 2007 ) . `` Effects of proton - pump inhibitors on functional dyspepsia : a meta - analysis of randomized placebo - controlled trials '' . Clinical Gastroenterology and Hepatology. 5 ( 2 ) : 178 -- 85 ; quiz 140 . doi : 10.1016 / j. cgh. 2006.09. 012 . PMID 17174612 . Jump up ^ Sachar H , Vaidya K , Laine L ( 2014 ) . `` Intermittent vs continuous proton pump inhibitor therapy for high - risk bleeding ulcers : a systematic review and meta - analysis '' . JAMA Internal Medicine . 174 ( 11 ) : 1755 -- 62 . doi : 10.1001 / jamainternmed. 2014.4056 . PMC 4415726 . PMID 25201154 . Jump up ^ Yuan Y , Ford AC , Khan KJ , Gisbert JP , Forman D , Leontiadis GI , Tse F , Calvet X , Fallone C , Fischbach L , Oderda G , Bazzoli F , Moayyedi P ( 2013 ) . `` Optimum duration of regimens for Helicobacter pylori eradication '' . Cochrane Database of Systematic Reviews . 12 : CD008337 . doi : 10.1002 / 14651858. CD008337. pub2 . PMID 24338763 . Jump up ^ Sigterman KE , van Pinxteren B , Bonis PA , Lau J , Numans ME ( 2013 ) . `` Short - term treatment with proton pump inhibitors , H2 - receptor antagonists and prokinetics for gastro - oesophageal reflux disease - like symptoms and endoscopy negative reflux disease '' . Cochrane Database of Systematic Reviews . 5 : CD002095 . doi : 10.1002 / 14651858. CD002095. pub5 . PMID 23728637 . Jump up ^ Qadeer MA , Phillips CO , Lopez AR , Steward DL , Noordzij JP , Wo JM , Suurna M , Havas T , Howden CW , Vaezi MF ( 2006 ) . `` Proton pump inhibitor therapy for suspected GERD - related chronic laryngitis : a meta - analysis of randomized controlled trials '' . The American Journal of Gastroenterology. 101 ( 11 ) : 2646 -- 54 . doi : 10.1111 / j. 1572 - 0241.2006. 00844. x . PMID 17037995 . Jump up ^ Chang AB , Lasserson TJ , Kiljander TO , Connor FL , Gaffney JT , Garske LA ( 2006 ) . `` Systematic review and meta - analysis of randomised controlled trials of gastro - oesophageal reflux interventions for chronic cough associated with gastro - oesophageal reflux '' . The BMJ. 332 ( 7532 ) : 11 -- 7 . doi : 10.1136 / bmj. 38677.559005. 55 . PMC 1325125 . PMID 16330475 . ^ Jump up to : Singh S , Garg SK , Singh PP , Iyer PG , El - Serag HB ( 2014 ) . `` Acid - suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett 's oesophagus : a systematic review and meta - analysis '' . Gut. 63 ( 8 ) : 1229 -- 37 . doi : 10.1136 / gutjnl - 2013 - 305997 . PMC 4199831 . PMID 24221456 . Jump up ^ Lucendo AJ , Arias Á , Molina - Infante J ( 2015 ) . `` Efficacy of Proton Pump Inhibitor Drugs for Inducing Clinical and Histological Remission in Patients with Symptomatic Esophageal Eosinophilia : A Systematic Review and Meta - Analysis '' . Clinical Gastroenterology and Hepatology. 14 ( 1 ) : 13 -- 22. e1 . doi : 10.1016 / j. cgh. 2015.07. 041 . PMID 26247167 . Jump up ^ Alhazzani W , Alenezi F , Jaeschke RZ , Moayyedi P , Cook DJ ( 2013 ) . `` Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients : a systematic review and meta - analysis '' . Critical Care Medicine . 41 ( 3 ) : 693 -- 705 . doi : 10.1097 / CCM. 0b013e3182758734 . PMID 23318494 . Jump up ^ Epelboym I , Mazeh H ( 2014 ) . `` Zollinger - Ellison syndrome : classical considerations and current controversies '' . Oncologist. 19 ( 1 ) : 44 -- 50 . doi : 10.1634 / theoncologist. 2013 - 0369 . PMC 3903066 . PMID 24319020 . Jump up ^ `` Five Things Physicians and Patients Should Question '' . American Gastroenterological Association . Jump up ^ Kahrilas , Peter J. ; Shaheen , Nicholas J. ; Vaezi , Michael F. ; Hiltz , SW ; Black , E ; Modlin , IM ; Johnson , SP ; Allen , J ; Brill , JV ( 2008 ) . `` American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease '' . Gastroenterology. 135 ( 4 ) : 1383 -- 1391 , 1391. e1 -- 5 . doi : 10.1053 / j. gastro. 2008.08. 045 . PMID 18789939 . ^ Jump up to : `` FDA Drug Safety Communication : Possible increased risk of fractures of the hip , wrist , and spine with the use of proton pump inhibitors '' . US Food and Drug Administration . 23 March 2011 . Retrieved 23 August 2015 . Jump up ^ Cooper , B.T. ; Chapman , W. ; Neumann , C.S. ; Gearty , J.C. ( 2006 ) . `` Continuous treatment of Barrett 's oesophagus patients with proton pump inhibitors up to 13 years : Observations on regression and cancer incidence '' . Alimentary Pharmacology and Therapeutics . 23 ( 6 ) : 727 -- 33 . doi : 10.1111 / j. 1365 - 2036.2006. 02825. x . PMID 16556174 . Jump up ^ Rossi S , editor . Australian Medicines Handbook 2006 . Adelaide : Australian Medicines Handbook ; 2006 . ISBN 0 - 9757919 - 2 - 3 Jump up ^ Clark , DW ; Strandell J ( June 2006 ) . `` Myopathy including polymyositis : a likely class adverse effect of proton pump inhibitors ? '' . European Journal of Clinical Pharmacology . 62 ( 6 ) : 473 -- 479 . doi : 10.1007 / s00228 - 006 - 0131 - 1 . PMID 16758264 . ^ Jump up to : Corleto VD , Festa S , Di Giulio E , Annibale B ( February 2014 ) . `` Proton pump inhibitor therapy and potential long - term harm '' . Current Opinion in Endocrinology , Diabetes and Obesity. 21 ( 1 ) : 3 -- 8 . doi : 10.1097 / MED. 0000000000000031 . PMID 24310148 . ^ Jump up to : Freedberg DE , Kim LS , Yang YX ( 2017 ) . `` The Risks and Benefits of Long - term Use of Proton Pump Inhibitors : Expert Review and Best Practice Advice From the American Gastroenterological Association '' . Gastroenterology. 152 ( 4 ) : 706 -- 715 . doi : 10.1053 / j. gastro. 2017.01. 031 . PMID 28257716 . Conclusions : Baseline differences between PPI users and non-users make it challenging to study potential PPI adverse effects retrospectively . Despite a large number of studies , the overall quality of evidence for PPI adverse effects is low to very low . When PPIs are appropriately prescribed , their benefits are likely to outweigh their risks . When PPIs are inappropriately prescribed , modest risks become important because there is no potential benefit . There is currently insufficient evidence to recommend specific strategies for mitigating PPI adverse effects . ^ Jump up to : Vaezi MF , Yang YX , Howden CW ( 2017 ) . `` Complications of Proton Pump Inhibitor Therapy '' . Gastroenterology. 153 ( 1 ) : 35 -- 48 . doi : 10.1053 / j. gastro. 2017.04. 047 . PMID 28528705 . In turn , this has caused unnecessary concern among patients and prescribers . The benefits of PPI therapy for appropriate indications need to be considered , along with the likelihood of the proposed risks . Patients with a proven indication for a PPI should continue to receive it in the lowest effective dose . PPI dose escalation and continued chronic therapy in those unresponsive to initial empiric therapy is discouraged . ^ Jump up to : Ito T , Jensen RT ( 2010 ) . `` Association of long - term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium , vitamin B , iron , and magnesium '' . Current Gastroenterology Reports . 12 ( 6 ) : 448 -- 57 . doi : 10.1007 / s11894 - 010 - 0141 - 0 . PMC 2974811 . PMID 20882439 . Jump up ^ Park CH , Kim EH , Roh YH , Kim HY , Lee SK ( 2014 ) . `` The association between the use of proton pump inhibitors and the risk of hypomagnesemia : a systematic review and meta - analysis '' . PLoS ONE . 9 ( 11 ) : e112558 . doi : 10.1371 / journal. pone. 0112558 . PMC 4230950 . PMID 25394217 . Jump up ^ Fujimori S ( 2015 ) . `` What are the effects of proton pump inhibitors on the small intestine ? '' . World J. Gastroenterol. 21 ( 22 ) : 6817 -- 9 . doi : 10.3748 / wjg. v21. i22. 6817 . PMC 4462721 . PMID 26078557 . Generally , proton - pump inhibitors ( PPIs ) have great benefit for patients with acid related disease with less frequently occurring side effects . According to a recent report , PPIs provoke dysbiosis of the small intestinal bacterial flora , exacerbating nonsteroidal anti-inflammatory drug - induced small intestinal injury . Several meta - analyses and systematic reviews have reported that patients treated with PPIs , as well as post-gastrectomy patients , have a higher frequency of small intestinal bacterial overgrowth ( SIBO ) compared to patients who lack the aforementioned conditions . Furthermore , there is insufficient evidence that these conditions induce Clostridium difficile infection . At this time , PPI - induced dysbiosis is considered a type of SIBO . Jump up ^ Erdogan A , Rao SS ( April 2015 ) . `` Small intestinal fungal overgrowth '' . Curr Gastroenterol Rep. 17 ( 4 ) : 16 . doi : 10.1007 / s11894 - 015 - 0436 - 2 . PMID 25786900 . Small intestinal fungal overgrowth ( SIFO ) is characterized by the presence of excessive number of fungal organisms in the small intestine associated with gastrointestinal ( GI ) symptoms . Candidiasis is known to cause GI symptoms particularly in immunocompromised patients or those receiving steroids or antibiotics . However , only recently , there is emerging literature that an overgrowth of fungus in the small intestine of non-immunocompromised subjects may cause unexplained GI symptoms . Two recent studies showed that 26 % ( 24 / 94 ) and 25.3 % ( 38 / 150 ) of a series of patients with unexplained GI symptoms had SIFO . The most common symptoms observed in these patients were belching , bloating , indigestion , nausea , diarrhea , and gas . The underlying mechanism ( s ) that predisposes to SIFO is unclear but small intestinal dysmotility and use of proton pump inhibitors has been implicated . However , further studies are needed ; both to confirm these observations and to examine the clinical relevance of fungal overgrowth , both in healthy subjects and in patients with otherwise unexplained GI symptoms . Jump up ^ Song , H ; Zhu , J ; Lu , D ( 2 December 2014 ) . `` Long - term proton pump inhibitor ( PPI ) use and the development of gastric pre-malignant lesions '' . The Cochrane Database of Systematic Reviews . 12 : CD010623 . doi : 10.1002 / 14651858. CD010623. pub2 . PMID 25464111 . Jump up ^ Münch A , Aust D , Bohr J , Bonderup O , Fernández Bañares F , Hjortswang H , et al. ( 2012 ) . `` Microscopic colitis : Current status , present and future challenges : statements of the European Microscopic Colitis Group '' . Journal of Crohn 's and Colitis. 6 ( 9 ) : 932 -- 45 . doi : 10.1016 / j. crohns. 2012.05. 014 . PMID 22704658 . Jump up ^ Jackson , Matthew A. ; Goodrich , Julia K. ; Maxan , Maria - Emanuela ; Freedberg , Daniel E. ; Abrams , Julian A. ; Poole , Angela C. ; Sutter , Jessica L. ; Welter , Daphne ; Ley , Ruth E. ( 2015 - 12 - 30 ) . `` Proton pump inhibitors alter the composition of the gut microbiota '' . Gut. 65 ( 5 ) : gutjnl -- 2015 -- 310861 . doi : 10.1136 / gutjnl - 2015 - 310861 . ISSN 1468 - 3288 . PMC 4853574 . 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Open Heart . 2 ( 1 ) : e000248 . doi : 10.1136 / openhrt - 2015 - 000248 . PMC 4488889 . PMID 26196021 . Jump up ^ Schepers E , Speer T , Bode - Böger SM , Fliser D , Kielstein JT ( 2014 ) . `` Dimethylarginines ADMA and SDMA : the real water - soluble small toxins ? '' . Seminars in Nephrology. 34 ( 2 ) : 97 -- 105 . doi : 10.1016 / j. semnephrol. 2014.02. 003 . PMID 24780466 . Retrieved 2015 - 06 - 11 . It also seems to be the pathophysiological link between the use of proton pump inhibitors and increased cardiovascular event rate because these drugs bind and inhibit DDAH , the enzyme that degrades ADMA , which results in higher ADMA levels and a decrease in bioavailable NO . Jump up ^ Lambert AA , Lam JO , Paik JJ , Ugarte - Gil C , Drummond MB , Crowell TA ( 2015 ) . `` Risk of community - acquired pneumonia with outpatient proton - pump inhibitor therapy : a systematic review and meta - analysis '' . PLoS ONE . 10 ( 6 ) : e0128004 . doi : 10.1371 / journal. pone. 0128004 . PMC 4456166 . PMID 26042842 . Jump up ^ Eom , CS ; Jeon , CY ; Lim , JW ; Cho , EG ; Park , SM ; Lee , KS ( 22 February 2011 ) . `` Use of acid - suppressive drugs and risk of pneumonia : a systematic review and meta - analysis '' . CMAJ : Canadian Medical Association Journal . 183 ( 3 ) : 310 -- 9 . doi : 10.1503 / cmaj. 092129 . PMC 3042441 . PMID 21173070 . Jump up ^ Schnoll - Sussman F , Katz PO ( 2017 ) . `` Clinical Implications of Emerging Data on the Safety of Proton Pump Inhibitors '' . Curr Treat Options Gastroenterol. 15 ( 1 ) : 1 -- 9 . doi : 10.1007 / s11938 - 017 - 0115 - 5 . PMID 28130652 . The methodology of these studies allows us to find an association with these events but does not provide us with sufficient evidence to determine causality . In general , the findings of the available studies do not fit with our clinical experience nor is the magnitude of the association sufficient to result in a major change in our practice . 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Baulkham Hills : Wyeth ; 2004 . Jump up ^ Shin , Jai Moo ; Munson , Keith ; Vagin , Olga ; Sachs , George ( 2008 ) . `` The gastric HK - ATPase : Structure , function , and inhibition '' . Pflügers Archiv -- European Journal of Physiology. 457 ( 3 ) : 609 -- 22 . doi : 10.1007 / s00424 - 008 - 0495 - 4 . PMC 3079481 . PMID 18536934 . Jump up ^ Carlsson , E ; Lindberg , P. ( 2002 ) . `` Two of a kind '' . Chemistry in Britain . 38 ( 5 ) : 42 -- 5 . Jump up ^ Kim HK , Park SH , Cheung DY , Cho YS , Kim JI , Kim SS , Chae HS , Kim JK , Chung IS ( 2010 ) . `` Clinical trial : inhibitory effect of revaprazan on gastric acid secretion in healthy male subjects '' . Journal of Gastroenterology and Hepatology. 25 ( 10 ) : 1618 -- 25 . doi : 10.1111 / j. 1440 - 1746.2010. 06408. x . PMID 20880169 . Jump up ^ Strand , Daniel S. ; Kim , Daejin ; Peura , David A. ( 15 January 2017 ) . `` 25 Years of Proton Pump Inhibitors : A Comprehensive Review '' . Gut and Liver. 11 ( 1 ) : 27 -- 37 . doi : 10.5009 / gnl15502 . access - date = requires url = ( help ) External links ( edit ) MedlinePlus Encyclopedia Wikimedia Commons has media related to Proton pump inhibitors . <Th_colspan="2"> Pharmacology : major drug groups Gastrointestinal tract / metabolism ( A ) stomach acid Antacids H antagonists Proton pump inhibitors Antiemetics Laxatives Antidiarrhoeals / Antipropulsives Anti-obesity drugs Anti-diabetics Vitamins Dietary minerals Blood and blood forming organs ( B ) Antithrombotics Antiplatelets Anticoagulants Thrombolytics / fibrinolytics Antihemorrhagics Platelets Coagulants Antifibrinolytics Cardiovascular system ( C ) cardiac therapy / antianginals Cardiac glycosides Antiarrhythmics Cardiac stimulants Antihypertensives Diuretics Vasodilators Beta blockers Calcium channel blockers renin -- angiotensin system ACE inhibitors Angiotensin II receptor antagonists Renin inhibitors Antihyperlipidemics Statins Fibrates Bile acid sequestrants Skin ( D ) Emollients Cicatrizants Antipruritics Antipsoriatics Medicated dressings Genitourinary system ( G ) Hormonal contraception Fertility agents SERMs Sex hormones Endocrine system ( H ) Hypothalamic -- pituitary hormones Corticosteroids Glucocorticoids Mineralocorticoids Sex hormones Thyroid hormones / Antithyroid agents Infections and infestations ( J , P , QI ) Antimicrobials : Antibacterials ( Antimycobacterials ) Antifungals Antivirals Antiparasitics Antiprotozoals Anthelmintics Ectoparasiticides IVIG Vaccines Malignant disease ( L01 -- L02 ) Anticancer agents Antimetabolites Alkylating Spindle poisons Antineoplastic Topoisomerase inhibitors Immune disease ( L03 -- L04 ) Immunomodulators Immunostimulants Immunosuppressants Muscles , bones , and joints ( M ) Anabolic steroids Anti-inflammatories NSAIDs Antirheumatics Corticosteroids Muscle relaxants Bisphosphonates Brain and nervous system ( N ) Analgesics Anesthetics General Local Anorectics Anti-ADHD agents Antiaddictives Anticonvulsants Antidementia agents Antidepressants Antimigraine agents Antiparkinson agents Antipsychotics Anxiolytics Depressants Entactogens Entheogens Euphoriants Hallucinogens Psychedelics Dissociatives Deliriants Hypnotics / Sedatives Mood Stabilizers Neuroprotectives Nootropics Neurotoxins Orexigenics Serenics Stimulants Wakefulness - promoting agents Respiratory system ( R ) Decongestants Bronchodilators Cough medicines H antagonists Sensory organs ( S ) Ophthalmologicals Otologicals Other ATC ( V ) Antidotes Contrast media Radiopharmaceuticals Dressings Senotherapeutics <Th_colspan="2"> Drugs for peptic ulcer and GERD / GORD ( A02B ) H antagonists ( `` - tidine '' ) Cimetidine Famotidine Lafutidine Lavoltidine ( loxtidine ) Niperotidine Nizatidine Ranitidine Roxatidine Prostaglandins ( E ) / analogues ( `` - prost - '' ) Misoprostol Enprostil Proton - pump inhibitors ( `` - prazole '' ) Azeloprazole Dexlansoprazole Esomeprazole Ilaprazole Lansoprazole Omeprazole Pantoprazole Picoprazole Rabeprazole Tenatoprazole Timoprazole Potassium - competitive acid blockers ( `` - prazan '' ) Linaprazan Revaprazan Soraprazan Vonoprazan Others Aceglutamide aluminum Acetoxolone Alginic acid Arbaclofen placarbil Bismuth subcitrate Carbenoxolone Cetraxate Gefarnate Lesogaberan Pirenzepine Proglumide Rebamipide Sucralfate Sulglicotide Telenzepine Teprenone Troxipide Zinc L - carnosine Zolimidine Combinations Bismuth subcitrate / metronidazole / tetracycline <Td_colspan="2"> See also : Helicobacter pylori eradication protocols Retrieved from `` https://en.wikipedia.org/w/index.php?title=Proton-pump_inhibitor&oldid=831630124 '' Categories : Proton pump inhibitors Gastroenterology Hidden categories : Wikipedia articles needing page number citations from March 2013 Pages using citations with accessdate and no URL Articles with short description Template : drugs.com link with non-standard subpage All articles with unsourced statements Articles with unsourced statements from February 2018 Articles containing potentially dated statements from May 2017 All articles containing potentially dated statements Talk Contents About Wikipedia বাংলা Català Dansk Deutsch Español فارسی Français Hrvatski Bahasa Indonesia Italiano עברית Kurdî Македонски Nederlands 日本 語 Polski Português Русский Slovenčina Slovenščina Српски / srpski Srpskohrvatski / српскохрватски Suomi Svenska ไทย Türkçe Українська 吴语 粵語 中文 22 more Edit links This page was last edited on 21 March 2018 , at 14 : 22 . 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