This document summarizes information about proton pump inhibitors (PPIs). It defines a proton pump and PPIs, explaining that PPIs reduce stomach acid production by blocking the proton pump enzyme. The document outlines the main uses of PPIs as relieving acid reflux and treating ulcers. It describes the mechanism of action of PPIs in blocking gastric acid secretion. Examples of common PPI drugs are provided. Risks of overuse are mentioned, as well as the need to step down therapy when stopping PPIs to avoid rebound acid effects.

1. Presentation
on
Proton Pump Inhibitor
Made by- Swagata Sarkar

2. Proton pump
• A proton pump is an integral membrane protein that builds up a proton
gradient across a biological membrane.

3. What are proton pump inhibitors(PPIs) ?
• Proton pump inhibitors(PPIs) reduce the production of acid by blocking the
enzyme in the wall of the stomach that produces acid.

4. Proton pump inhibitors are used to:
• Relieve symptoms of acid reflux, or gastroesophageal reflux disease(GERD).
This is a condition in which food or liquid moves up from the stomach to
the esophagus (the tube from the mouth to the stomach).
• Treat a duodenal or stomach ulcer.
• Treat damage to the lower esophagus caused by acid reflux.

5. The Mechanism of action of proton pump inhibitors :
• Proton pump inhibitors (PPIs) block the gastric H,K-ATPase, inhibiting
gastric acid secretion.
• This effect enables healing of peptic ulcers, gastroesophageal reflux disease
(GERD), Barrett's esophagus, and Zollinger-Ellison syndrome, as well as the
eradication of Helicobacter pylori as part of combination regimens.

6. List of examples of PPIs
• Omeprazole
• Lansoprazole
• Esomeprazole
• Rabeprazole
• Pantoprazole

7. Overuse of PPI
■ Retrospective, chart review of non-ICU admits
■ 22% received stress ulcer prophylaxis
■ 54% of those were discharged home on it
■ Retrospective chart review of nursing home admits
■ 50% did NOT have an appropriate diagnosis for PPI
■ Retrospective chart review of C.diff positive patients
63% of did NOT have valid indication for PPI
■ Retrospective chart review of cirrhotics + SBP
■ 47% did NOT have valid reason for PPI

8. Stopping a PPI: Rebound Acid
■ High Gastrin Levels
■ Rebound Acid
■ Step down therapy?
■ Warn patients of
symptoms
■ Advise PRN H2 blocker
therapy
Reimer et al. Gastro 2009; 137: 80-87
Niklasson et al. Am J Gastro 2010; 105: 1531-1537

9. Clinical Pearls
■ Hepatic Encephalopathy
■ Ammonia level of limited use
■ Low protein diets can harm patient
■ Pain Medication
■ Attempt Tylenol in limited doses
■ Next would attempt Tramadol
■ Consider Fentanyl or Hydromorphone in lower doses,
less frequency

10. Thank you