PMID- 36768710
OWN - NLM
STAT- MEDLINE
DCOM- 20230214
LR  - 20230214
IS  - 1422-0067 (Electronic)
IS  - 1422-0067 (Linking)
VI  - 24
IP  - 3
DP  - 2023 Jan 25
TI  - Appropriateness of Proton Pump Inhibitor Prescription Evaluated by Using 
      Serological Markers.
LID - 10.3390/ijms24032378 [doi]
LID - 2378
AB  - Inappropriate prescription of proton pump inhibitors (PPI) has been widely 
      reported, often lacking initial exclusion of Helicobacter pylori (HP) infection 
      and evaluation of gastric functional status. The aim of this study was to 
      evaluate the utility of gastric functional tests to define the acid output, as 
      well as HP status, in order to better direct PPI therapy prescription. Dyspeptic 
      patients without alarm symptoms from a primary care population were evaluated. 
      For each patient, serum Pepsinogen I (PGI) and II (PGII), gastrin 17 (G17) and 
      anti-HP IgG antibodies (Biohit, Oyj, Finland) were determined. For each subject, 
      data were collected regarding symptoms, past medical history of HP infection, and 
      PPI use. Therapeutic response to PPIs was determined according to PGI and G17 
      values, where G17 > 7 in the presence of elevated PGI and absence of chronic 
      atrophic gastritis (CAG) was considered an adequate response. Among 2583 
      dyspeptic patients, 1015/2583 (39.3%) were on PPI therapy for at least 3 months 
      before serum sampling, and were therefore included in the study. Active HP 
      infection and CAG were diagnosed in 206 (20.2%) and 37 (3.6%) patients, 
      respectively. Overall, an adequate therapeutic response to PPIs was observed in 
      34.9%, reaching 66.7% at the highest dose. However, 41.1% and 20.4% of patients 
      showed low (G17 1-7) or absent (G17 < 1) response to PPI, regardless of the 
      dosage used. According to gastric functional response, most patients currently on 
      PPI maintenance therapy lack a proper indication for continuing this medication, 
      either because acid output is absent (as in CAG) or because gastrin levels fail 
      to rise, indicating absence of gastric acid negative feedback. Lastly, HP 
      eradication is warranted in all patients, and gastric function testing ensures 
      this pathogen is sought for and adequately treated prior to initiating long-term 
      PPI therapy.
FAU - Russo, Michele
AU  - Russo M
AD  - Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine 
      and Surgery, University of Parma, 43121 Parma, Italy.
FAU - Rodriguez-Castro, Kryssia Isabel
AU  - Rodriguez-Castro KI
AD  - Endoscopy Unit, Department of Medicine, ULSS7 "Pedemontana", "Alto Vicentino" 
      Hospital, 36014 Santorso, Italy.
FAU - Franceschi, Marilisa
AU  - Franceschi M
AD  - Endoscopy Unit, Department of Medicine, ULSS7 "Pedemontana", "Alto Vicentino" 
      Hospital, 36014 Santorso, Italy.
FAU - Ferronato, Antonio
AU  - Ferronato A
AD  - Endoscopy Unit, Department of Medicine, ULSS7 "Pedemontana", "Alto Vicentino" 
      Hospital, 36014 Santorso, Italy.
FAU - Panozzo, Maria Piera
AU  - Panozzo MP
AD  - Laboratory of Clinical Pathology, ULSS7 "Pedemontana", "Alto Vicentino" Hospital, 
      36014 Santorso, Italy.
FAU - Brozzi, Lorenzo
AU  - Brozzi L
AD  - Endoscopy Unit, Department of Medicine, ULSS7 "Pedemontana", "Alto Vicentino" 
      Hospital, 36014 Santorso, Italy.
FAU - Di Mario, Francesco
AU  - Di Mario F
AD  - Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy.
FAU - Crafa, Pellegrino
AU  - Crafa P
AUID- ORCID: 0000-0001-8603-863X
AD  - Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy.
FAU - Brandimarte, Giovanni
AU  - Brandimarte G
AD  - Division of Internal Medicine and Gastroenterology, "Cristo Re" Hospital, 00167 
      Rome, Italy.
FAU - Tursi, Antonio
AU  - Tursi A
AUID- ORCID: 0000-0001-5767-5541
AD  - Territorial Gastroenterology Service, ASL BAT, 76123 Andria, Italy.
LA  - eng
PT  - Journal Article
DEP - 20230125
PL  - Switzerland
TA  - Int J Mol Sci
JT  - International journal of molecular sciences
JID - 101092791
RN  - 0 (Proton Pump Inhibitors)
RN  - 9001-10-9 (Pepsinogen A)
SB  - IM
MH  - Humans
MH  - Proton Pump Inhibitors/pharmacology/therapeutic use
MH  - *Gastritis, Atrophic
MH  - *Helicobacter Infections/drug therapy/diagnosis
MH  - Pepsinogen A
MH  - *Helicobacter pylori
PMC - PMC9917011
OTO - NOTNLM
OT  - Helicobacter pylori
OT  - acid output
OT  - gastric function
OT  - gastrin
OT  - pepsinogen
OT  - proton pump inhibitors
OT  - reflux disease
COIS- This research received no external funding and authors declare no competing 
      interest.
EDAT- 2023/02/12 06:00
MHDA- 2023/02/15 06:00
PMCR- 2023/01/25
CRDT- 2023/02/11 01:21
PHST- 2022/11/28 00:00 [received]
PHST- 2023/01/18 00:00 [revised]
PHST- 2023/01/21 00:00 [accepted]
PHST- 2023/02/11 01:21 [entrez]
PHST- 2023/02/12 06:00 [pubmed]
PHST- 2023/02/15 06:00 [medline]
PHST- 2023/01/25 00:00 [pmc-release]
AID - ijms24032378 [pii]
AID - ijms-24-02378 [pii]
AID - 10.3390/ijms24032378 [doi]
PST - epublish
SO  - Int J Mol Sci. 2023 Jan 25;24(3):2378. doi: 10.3390/ijms24032378.