Clinically, proton pump inhibitor (PPI) represented by omeprazole, as one of the most effective drugs for inhibiting gastric acid, is widely used in the treatment of digestive system diseases such as chronic gastritis, gastric ulcer, radical eradication of Helicobacter pylori, upper gastrointestinal bleeding, etc., and is called "medicine for treating stomach diseases". So that as long as there are multiple-choice questions about stomach diseases in the physical examination, it is generally not wrong to blindly choose "omeprazole" without looking at the stalk.
So what is omeprazole, and how can it have such an effect? When the stomach is sick, can it be used to treat diseases unscrupulously? Today, Dr. Wu, a digestive professional, takes omeprazole as an example to explain the misunderstandings and precautions in the daily use of PPI, so that everyone can clearly take medicine and nourish their stomach with peace of mind ~
There are all kinds of particle exchanges in our body all the time, and hydrogen ions are the effective particle components of gastric acid. There is an energy-dependent ion pump on the cell membrane. The function of this pump is to exchange potassium ions with hydrogen ions, which are discharged to form gastric acid to digest and decompose food. One of the most important characteristics of omeprazole and other drugs is to effectively prevent gastric acid secretion by inhibiting the hydrogen, potassium and ATPase pump on the cell membrane of gastric wall (which is the last step of gastric acid secretion), so it is called "proton pump inhibitor".
As we all know, gastric acid, from another point of view, is hydrochloric acid, which is an important digestive juice to promote food digestion and is of great significance to the smooth operation of our digestive function. But in fact, on the other hand, it is also one of the culprits of various stomach diseases. Hyperacidity will corrode gastric mucosa. In physiological state, gastric acid can digest food without damaging gastric mucosa because of the protective effect of protective barrier on gastric mucosa. A layer of weakly alkaline mucus is often attached to the gastric mucosa, which can neutralize part of gastric acid and block the contact between gastric acid and gastric wall. We call it the mucus barrier. If mucus secretion is too little, or gastric acid secretion is too much, and helicobacter pylori infection, stress factors or alcohol and tobacco stimulation exist for a long time, gastric acid will slowly erode and break through the barrier and invade the gastric mucosa to form gastritis or ulcer.
Therefore, when chronic gastritis and peptic ulcer are caused by excessive gastric acid secretion, acid inhibitors prevent excessive gastric acid secretion and reduce the stimulation of gastric acid. Of course, it is "medicine to cure the disease."
Dr. Wu summed up the past clinical experience and found that many patients did not take the medicine according to the routine requirements, which also led to many problems: mild symptoms were repeated, and severe cases would lead to more complications.
For example, atrophic gastritis, except some patients with acid reflux can take omeprazole, the gastric acid secreted by other patients after gland atrophy decreases. Taking omeprazole at this time will aggravate the condition of some people and even cause the risk of gastric cancer. This situation belongs to the category of irrational drug use.
Then let's take a look at the misunderstandings in the use of PPI.
Besides omeprazole, common proton pump inhibitors mainly include lansoprazole, pantoprazole, rabeprazole and esomeprazole. They all play an important role in the treatment of various stomach diseases. These drugs are easy to buy in pharmacies now, so many old patients with stomach problems or some people who have heard from hearsay prescribe their own drugs as soon as they have stomach problems. As everyone knows, there may be many misunderstandings in this approach:
Myth 1: Do not take medicine according to the course of treatment.
There are three main misunderstandings about the course of PPI use, namely, the course of medication is too short, the course of medication is too long and the medication is irregular.
Generally speaking, PPI should be used for 4 ~ 8 weeks for erosive gastritis, gastroduodenal ulcer and other diseases that need gastric mucosal self-repair, so as to fully reduce the interference of gastric acid on mucosal repair and make the rotten surface or ulcer surface heal as soon as possible. Often, patients may feel much more comfortable with their stomachs after taking PPI for a few days, so they stop taking the medicine without authorization or simply take the medicine intermittently. In this way, the gastric mucosa can not get a stable growth and repair environment, and the natural state will be repeated.
And if you take medicine beyond the course of treatment, it will bring many complications, which will be mentioned later.
Myth 2: Regardless of indications.
Compared with the misunderstanding of not taking medicine according to the course of treatment, taking medicine blindly without considering the indications may be more harmful. In theory, all stomach diseases related to excessive gastric acid secretion or digestion can take PPI. In the authoritative medical database so far, the indications of PPI treatment include: peptic ulcer, gastroesophageal reflux disease, gastrinoma syndrome (also known as Zhuo-Ai syndrome, a disease of hyperacidity and ulcer), non-steroidal anti-inflammatory drugs-related ulcer and eradication of Helicobacter pylori.
Therefore, just like the medication of atrophic gastritis mentioned above, people who take omeprazole as long as they have stomachache or stomachache, whether they like it or not, will have overdose or over-indication. You know, PPI only plays a role in inhibiting gastric acid secretion, not a painkiller, and it cannot cure all diseases.
However, if PPI is taken excessively or over-indicated for a long time, it may cause emaciation, intestinal flora disorder, diarrhea and malabsorption of trace elements such as calcium, magnesium and vitamin B 12. In severe cases, it may also lead to atrophic gastritis canceration, Alzheimer's disease or renal insufficiency. These side effects of PPI have been confirmed by a large number of studies and need to be paid attention to.
Myth 3: Do not pay attention to drug interactions.
Some friends pay attention to the timing and course of treatment when taking PPI, but don't tell them what other drugs are taken at the same time, which leads to the interaction between drugs and affects the curative effect. Drugs that may interact with proton pump inhibitors are:
1. Clopidogrel, a platelet aggregation inhibitor;
2.HIV protease preparations, such as ribavirin and azanavir;
3. Immunosuppressant methotrexate.
If you are taking one of these drugs before you decide to use PPI, you'd better talk to your bed care doctor or outpatient doctor to avoid drug interaction.
The above three misunderstandings will certainly attract many people in daily life. Although the PPI of omeprazole is not small, if it is not used reasonably under the guidance of a doctor, the consequences will be endless.
In order to avoid the above three misunderstandings, and for us to better relieve discomfort by taking PPI, Dr. Wu gives you the following suggestions:
The best time to take 1.PPI is 30~60 minutes before meals. If you only take it once a day, it is recommended to take it before breakfast. Studies have shown that taking PPI for a period of time before meals can inhibit proton pump to the maximum extent, thus exerting the greatest curative effect;
2. Avoid using acid inhibitors at the same time. Generally speaking, an acid inhibitor is enough to cope with the corresponding scenario. In addition to PPI, traditional acid inhibitors include H2 receptor antagonists and prostaglandin E analogues. If used at the same time, it will not improve the acid inhibition effect, but will reduce the efficacy and increase the risk of side effects.
3. It is a long process not to stop taking medicine or to stop taking medicine by yourself. Although PPI can produce effect in a short time, if the drug is stopped or stopped without authorization, it will lead to repeated illness and even rebound of gastric acid secretion, which will aggravate the symptoms;
4. Pay attention to the course of treatment of peptic ulcer is generally 4-8 weeks in the stomach, the ulcer caused by non-steroidal anti-inflammatory drugs is at least 8 weeks, and the eradication of Helicobacter pylori is generally less than 2 weeks. Although they are all using acid inhibitors, the length of treatment is still different. Taking medicine for too long or too short will not play a positive role in the recovery of the disease;
5. Pay attention to the reaction between drugs, truthfully describe to the doctor other drugs you have taken or intend to take in the future, and the doctor will decide the treatment plan.
In short, for the use of PPI, the most important thing is to take medicine and stop taking medicine according to the doctor's advice.
As the saying goes, a long illness makes a good doctor, but in Dr. Wu's view, this sentence is extremely misleading: it will make some people mistakenly think that they have really become "experts" and dictate other people's diseases. I met such a patient when I was out of the clinic before. When waiting in line, he will chat with people around him and even help me "see a doctor and prescribe medicine": "Just take omeprazole for your ulcer. You don't believe it, he will open it like this when you see a doctor. "
In fact, most patients look down, I did prescribe some acid inhibitors for ulcer patients, and then treat them with mucosal protective agents. However, in terms of rational drug use, doctors prescribe drugs not only because it is an ulcer, but also because it is as simple as prescribing antacids. Although everyone may prescribe the same medicine, the process of thinking in your mind varies from person to person depending on the symptoms and test results.
Generally, the symptoms and diagnosis of patients will be considered when prescribing drugs, combined with age, duration of onset, family history, drug history, surgical history, allergic history and so on. And even think about the doctor's compliance. Far away, let's talk about omeprazole today. We all know that it is a "medicine for stomach trouble". Taking one tablet for stomachache is basically effective. But I didn't know it had such knowledge, not only the rules of course of treatment, but also the hidden dangers of complications and drug interaction, and even when to eat it was quite particular.
In foreign countries, prescription drugs are strictly controlled, which is not ideal in domestic pharmacies Controlling prescription drugs is not inconvenient for ordinary people to take medicine, but more from the perspective of rational drug use.
Finally, Dr. Wu still wants to mention an old saying: three points of medicine are poisonous. I hope that after reading today's article, you can have a basic concept of rational drug use. When taking or stopping drugs, listen to the doctor's words, read the instructions and check the relevant popular science articles. I believe that if you do this, you will definitely step on several misunderstandings and achieve the ideal curative effect more efficiently.