Gastric antisecretories (Affsaps)

February 2017

Acid blockers: indications in the adult (Afssaps)


The Afssaps published in November 2007 recommendations of good practice concerning acid blockers in the adult.

Afssaps raises that in 2007, "the pharmacological and clinical data show a superiority acid blockers of Proton pump inhibitors (PPI) compared to the inhibitors of the receivers H2 to histamine (anti-H2)".

Afssaps thus introduces the recommendations by specifying the main features of the PPI: their tolerance is good but their use must be reasoned. An endoscopy is essential before any regulation, except:
  • In the case of a typical gastro-esophageal reflux at least weekly in a patient of less than 60, without sign of alarm;
  • In preventing the lesions induced by the NSAID among patients of more than 65 or having risk factors.



Main features of acid blockers


Afssaps points out the role of acid blockers: they "inhibit the hydrochloric acid secretion by the parietal cells of the stomach either by blocking the H+K+ATPase enzyme responsible for the secretion of the ion H+ to the apical pole of cell (PPI) or by blocking the membrane receivers H2 with histamine to the vascular pole (anti-H2)".
  • Anti-H2 Blockers
    • Fast effect, short, of moderate intensity;
    • Secretary inhibition marked for basal acid secretion.
  • PPI blocker
    • Powerful action, dependant dose;
    • Not easily controllable night acidity;
    • Advised intake before the first meal of the day by oral way.


Both are very well tolerated.

Afssaps specifies that, for the blockers, we use "the terms of full amount (or standard dose) or of half-amount". Here are the corresponding amounts of anti-H2 and PPI:

Gastro-esophageal reflux (GORD)


Here is the treatment recommended by Afssaps in the case of a RGO:
  • Antacid, alginates, anti-H2 if the symptoms are typical and spaced;
  • PPI with half-amount during approximately 1 month if the symptoms are typical and are closer;
  • PPI with half-amount in the event of non severe esophagitis, to full amount if severe;
  • PPI with minimal amount in the event of frequent or early relapses with the discontinuation of treatment.


Affsaps specifies that there "is no proof for the effectiveness of the acid blockers in the relief of isolated extra-digestive demonstrations such as the ENT symptoms, chronic cough, asthma, the non-cardiac chest pains. "

Lesions induced by Non-steroidal anti-inflammatory drugs (NSAID)


Here are the treatments recommended by Afssaps in the case of a lesion induced by NSAID:
  • IP with full amount (with half proportions as prevention of the endoscopic lesions);
  • Misoprostol (800 ? g/j) in curative and preventive therapy of ulcers induced by NSAID;
  • Insufficent argument to recommend the systematic association of acid blockers during the isolated use of a low-dose aspirin or another antiplatelet drug.

Other disorders


Afssaps also specifies, in its collection of recommendations, the diagnoses and treatment to be adopted in these other cases:
  • Gastric and duodenal ulcer;
  • Dyspepsia;
  • Acute lesions of stress;
  • Digestive hemorrhages;
  • Infection with Helicobacter Ppylori.

Sources


To consult the totality of the recommendations of Afssaps concerning acid blockers in the adult and related arguments.

Photographic copyright © Bob Davies - Fotolia.com

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