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THE IMPACT OF LONG-TERM USAGE OF PROTON PUMP INHIBITOR MEDICINES ON BLOOD LEVELS OF MAGNESIUM SALTS
*Dr. Baseem Ali Hussein and Dr. Mohammed Shakir Fashal
Introduction: Late 1980s proton pump inhibitors (PPIs) enhanced acidity-related disease treatment. They reduce stomach acid best. PPIs work better than other anti-secretory drugs because they permanently inhibit the stomach H+/K+ ATPase, the final step of acid secretion. They are often recommended for GERD, peptic ulcer disease, and other stomach acid-related disorders. PPIs are generally safe, however they may cause pneumonia, diarrhoea, iron and vitamin B12 deficiency, Clostridium difficile colitis, and hypomagnesemia.[3,4] Maintenance Patients with gastro-esophageal reflux illness often use PPIs. Some studies show that PPIs reduce GERD symptoms and treat esophagitis. A meta-analysis found that proton pump inhibitors relieved heartburn 11.5 percent of the time, compared to 6.4 percent for H2 receptor antagonists. Esophagitis commonly returns, so acid suppression medicine is needed.[6,7] The speed of relapse after a trial off antisecretory medicines may indicate if maintenance medication is needed. Acute treatment may sustain remissions lasting more than three months, but recurring symptoms in less than three months indicate sickness best managed with continued medication. Long-term drug usage (more than a year for PPIs) raises safety concerns. Long-term safety concerns for proton pump inhibitors (PPIs) include stomach shrinkage, persistent hypochlorhydria and hypergastrinemia, and PPIs. Hypochlorhydria may lead to infections and malabsorption. Numerous studies have connected PPI use to intestinal magnesium absorption-related hypomagnesaemia. Magnesium is the body's fourth most abundant cation and second intracellular cation. Magnesium is 1,000 mmols per adult (22-26gm). Healthy people have 1.5–2.0 mg/dl plasma Mg. Bone contains 60% of the body's calcium, 30% of which is exchangeable and stabilises blood calcium levels. It also reinforces the skeleton. 20% is in skeletal muscle, 19% in soft tissues, and 1% in extracellular fluid.[14,15] Magnesium is needed for ATP transport and over 300 other metabolic processes. It improves heart rhythm, immunological function, muscle and neuron function, and bone density. It regulates blood pressure, sugar, protein, and energy metabolism.[16,17] The kidneys excrete Mg, the stomach absorbs it, and bone stores it. Magnesium levels below 0.61 mmol/L (1.5 mg/dl) are low. High-dose oral magnesium supplementation may treat hypomagnesaemia since urine magnesium excretion is low. Chronic usage of omeprazole and other proton pump inhibitors (usually over a year) may cause hypomagnesaemia (PPIs). Hypomagnesaemia disappears after PPI medication stops.[20,21] Reports indicate 38 hypomagnesaemia cases connected to PPI use. The FDA issued a warning advisory acknowledging severe hypomagnesaemia connected to long-term PPI use after 15 further cases were recorded. In March 2011, the FDA warned healthcare providers about hypomagnesaemia in long-term PPI users. The FDA urges doctors to evaluate patients' blood magnesium levels while giving PPIs to long-term users or those on other hypomagnesemia-causing medicines (eg, digoxin or diuretics). The aim of this study was to examine the effect of the use PPIs for more than 3 months on serum magnesium level, and compare the result with serum Mg level of healthy control from adult people.[Full Text Article]