Administration of proton pump inhibitors in patients requiring enteral nutrition.

Abstract

Role of Proton Pump Inhibitors Patients requiring enteral nutrition may also be in need of acid-suppressing therapy with proton pump inhibitors (PPIs). Currently, five PPIs are available in the U.S.: omeprazole (Prilosec, AstraZeneca), omeprazole/sodium bicarbonate (Zegerid, Santarus), esomeprazole (Nexium, AstraZeneca), lansoprazole (Prevacid, Tap/Takeda), pantoprazole (Protonix, Wyeth), and rabeprazole (Aciphex, Eisai). All of these products are available in oral form, and several are also available in an intravenous (IV) form (Table ​(Table11).1 Table 1 Formulations of Proton Pump Inhibitors (PPIs) Available in the U.S. PPIs are highly effective for the treatment of gastroesophageal reflux disease (GERD), ulcers, and gastrointestinal (GI) bleeding. Indications approved by the FDA for each PPI are provided in Table ​Table11. When gastric contents are at a pH of below 2, protein de-naturation and the conversion of pepsinogen to pepsin occur and can lead to irritation of the esophagus.2 Other factors such as histamine and gastrin also play a role in the secretion of gastric acid with resulting esophageal irritation.3 Gastric contents at a pH of less than 4 for extended periods of time have been associated with a higher severity of disease. Therefore, it is not surprising that time spent at a pH above 4 has been correlated with esophageal healing.2 PPIs exhibit their effects by inhibiting H+/K+-adenosine triphosphatase (ATPase) in parietal cells.2,3 This inhibition sufficiently raises and maintains gastric pH to exceed 4.2 Currently available PPIs can maintain this pH level 50% to 60% of the time.2