Effects Of Long-term Use Of Proton Pump Inhibitor On The Human Body

Objective: Proton pump inhibitors or H⁺-K⁺-ATP inhibitors, which blockthe final step in the secretion of gastric acid, acid suppression effect is stronger,more specificity, longer duration. Since1988, the first PPIs omeprazole, hasbeen widely used in clinical PPIs and lansoprazole, pantoprazole, raybellaazoles and esomeprazole etc.. They have been proven to be effectivemitigation and treatment of acid related diseases. Domestic and foreignscholars used to think that PPIs is a kind of drug safety, little side effect. Inpatients with gastroesophageal reflux disease, PPIs is a large dose of long-termuse. Along with the aging of population, prevalence of coronary heart diseaseincreased year by year, more and more patients received antiplatelet therapywith aspirin, clopidogrel. Among them, high risk of upper gastrointestinalbleeding in patients receiving long-term PPIs treatment also need. Omeprazolehas become over-the-counter drugs, many patients can buy and use the drugs.With the wide application of PPIs, more and more scholars found, long-term use of PPIs may lead to hypergastrinemia, vitamin B₁2absorb anobstacle, hypomagnesemia, osteoporosis. At the same time in oral PPIs leadsto many patients, other drugs used in the treatment of pernicious anemia,osteoporosis, bring heavy burden to society and family. Through the study ofthe long-term application of PPIs in dynamic monitoring of serum gastrin,vitamin B₁2, magnesium, calcium, bone density, to explore the effects oflong-term application of PPIs on the human body, the incidence and severityof the adverse reactions, the clinical medical workers to consider thelong-term use of PPIs in a wide range, must pay attention to its adverse effects.To remind the majority of medical workers, strict control of indications andtreatment. Method：1case selectionFrom November to20122011February in35cases of the Third Hospitalof Hebei Medical University Department of Gastroenterology or departmentof Cardiology patients.1.1Criteria for age18-80years old; all patients before the experiment began1months had not taken bismuth, proton pump inhibitors, antacid and antibioticsand other drugs; all patients underwent rapid urease of Helicobacter pylori or¹4C-urea breath test （¹4C-urea breath teat,¹4C-UBT） for detection ofHelicobacter pylori in patients diagnosed with; reflux esophagitis afterelectronic gastroscopy, and according to the diagnostic classification1999Losangeles reflux esophagitis endoscopy; diagnosis for coronary heart diseasepatients after coronary artery angiography examination, by the Department ofCardiology specialist doctors diagnosed and the need for long-term takingaspirin or aspirin plus clopidogrel.1.2Exclusion criteria of serious heart, lung function is not complete, cannotaccept patients with electronic gastroscopy; patients with allergic history ofexperimental drugs; pregnant and lactating women with mental disorders;compliance of patients; rule out the presence of anemia, severe osteoporosisand had a history of patients with gastrointestinal operation.1.3Termination of experimental indications: serious adverse reactionsoccurred during the test, cannot tolerate; during the treatment of patients withother diseases were observed during the treatment of pregnancy interference.1.4General situation:2011November to2012February selected in the ThirdHospital of Hebei Medical University Department of Gastroenterology ordepartment of cardiology patients with a total of35cases. Among the23casesof male patients,12female patients. The average age of58.29years （26-76years）. Patients with reflux esophagitis in18cases,17cases of patients withcoronary heart disease.2materialInstrument and equipment：Electronic gastroscopy by Olympus companyproduction of GIF-XQ240, GIF-XQ260, GIF-H260electronic gastroscope; rapid diagnostic kit for H.pylori detection: application of rapid urease testNingbo Meikang biological technology limited production of H.pylori;¹4C-UBT Shenzhen Zhonghe head vesun material science and technologylimited production of liquid flash H.pylori tester HUBT-01and urea14Ccapsule; blood gastrin, vitamin B₁2levels detected by Beijing Haike BiotechCorp production of gastrin, vitamin B₁2assay kit; serum magnesium, calciumdetermined by Johnson Shanghai medical Audio Supplies Company Limitedproduction of VITROS Fusion5.1automatic biochemical analysis system andhigh speed centrifuge; bone mineral density was measured by application ofFrench Medlink company OSTEOCORE3dual energy bone densityinstrument.3method3.1test methodsDuring the period from2011November to2012February in the ThirdHospital of Hebei Medical University Department of digestive endoscopyroom to accept electronic gastroscopy diagnosis for patients with refluxesophagitis, met the inclusion criteria were included in the experiment; in2011November to2012February in Department of Cardiology, ThirdHospital of Hebei Medical University, received coronary angiographyexamination confirmed the diagnosis of coronary artery disease, after seniorcardiologists consultation that need long-term oral anti-platelet drugclopidogrel, aspirin, and high-risk patients with upper gastrointestinalhemorrhage, met the inclusion conditions were included in this experiment.All selected cases were before, application of esomeprazole therapy after3months,6months and12months four blood tests and bone density detection.H.pylori was detected in all patients underwent a rapid urease test and/or¹4C-UBT, clear H.pylori infection. If positive, the first blood test,measurement of bone mineral density after first give H.pylori eradicationtherapy. Eradication programs:5days before the application of esomeprazole20mg+amoxicillin1000mg,2/days,5days after the application ofesomeprazole20mg+clarithromycin500mg+furazolidone100mg,2/. Then as in patients without H.pylori infection, treated with esomeprazole20mg.3.2observation indexApplication of esomeprazole before, after3months,6months,12months,four time points respectively, blood detection of serum gastrin, vitamin B₁2,magnesium, calcium and bone density measurement.4statistical methods: using SPSS13.0statistical software to deal with data.Measurement data using the mean±standard deviation representation, dataprocessing variance with repeated measures design data analysis, there werestatistically significant differences in p<0.05. The LSD method to comparedifferent time point data were compared using repeated measure design data oftwo two, p<0.05, the difference was statistically significant.Results：1the completion of experimentAll enrolled35patients received oral esomeprazole treatment. Of which18cases of reflux esophagitis patients, coronary heart disease17cases withhigh risk bleeding of patients need long-term taking aspirin and clopidogrel ondigestion or.2cases were lost, for the patients with reflux esophagitis. A totalof33patients completed the trial, no termination test cases.2The change of serum gastrin was statistically significant, F=110.325,p=0.000. Prior to the application of esomeprazole treatment serum gastrin was135.846±9.13pg/ml, after3months was224.966±11.60pg/ml, after6months was279.314±11.17pg/ml, after12months was346.265±10.50pg/ml.With the application of esomeprazole time prolonged, the serum gastrinincreased.3Serum vitamin B₁2have significant change, F=8.100, p=0.000. Prior tothe application of esomeprazole treatment serum vitamin B₁2was387.39±25.55pg/ml,3month after the treatment was429.34±28.11pg/ml,6monthafter the treatment was443.07±21.39pg/ml,12month after the treatment was345.59±24.88pg/ml. With the application of esomeprazole time prolonged,decreased serum levels of vitamin B₁2in the medication after twelfth months.4There is a significant difference of serum calcium, F=13.729, p=0.000. Prior to the application of esomeprazole for calcium was2.23±0.027mmol/ml, after3months was2.21±0.030mmol/ml, after6months was2.08±0.050mmol/ml,12month after the treatment was2.035±0.027mmol/ml. Withthe application of esomeprazole time prolonged, serum calcium leveldecreased gradually.5The change of serum magnesium was not statistically significant,F=2.734, p=0.077. Prior to the application of esomeprazole magnesium is0.985±0.039mmol/ml, after3months was0.996±0.034mmol/ml,6monthafter the treatment was0.975±0.020mmol/ml,12month after the treatmentwas0.902±0.021mmol/ml.6The changes of bone mineral density was statistically significant,F=23.962, p=0.000. Prior to the application of esomeprazole therapy of bonedensity was0.707±0.012g/cm², after3months was0.700±0.014g/cm²,after6months was0.672±0.014g/cm², after12months was0.657±0.013g/cm². With the application of esomeprazole time prolonged, bone densitylevel appear declining trend.7Long-term use of PPIs patients. The changes and differences of gastrinin patients with H.pylori negative H.pylori was not statistically significant,F=89.369, p=0.089Conclusion:In the application of esomeprazole1years process:1The serum gastrin level increased gradually, application of changes ofserum gastrin before and after esomeprazole has significant difference.2The concentration of calcium, bone mineral density level appeardeclining trend, application of change before and after esomeprazole hassignificant difference.3There was no significant difference between the change of serumvitamin B₁2levels. There was no significant difference between the changes, serum magnesium level, no severe hypomagnesaemia occurs.