PPITherapie

PPITherapie, also known as proton‑pump‑inhibitor therapy, is a pharmacological treatment that reduces gastric acid secretion by inhibiting the hydrogen‑potassium ATPase enzyme (the proton pump) located in the parietal cells of the stomach lining. The class of drugs includes omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole, among others. By raising gastric pH, PPITherapie promotes healing of acid‑related mucosal damage and alleviates symptoms associated with hypersecretory conditions.

The principal indications for PPITherapie are gastro‑oesophageal reflux disease (GERD), peptic ulcer disease, Helicobacter pylori eradication regimens (as adjunctive therapy), Zollinger‑Ellison syndrome, and the prevention of non‑steroidal anti‑inflammatory drug (NSAID)‑induced gastropathy. Treatment duration varies: short courses of 4–8 weeks are typical for uncomplicated GERD or ulcer healing, while chronic maintenance may be prescribed for recurrent disease or severe reflux.

The therapeutic effect is achieved through irreversible binding of the drug to the luminal side of the proton pump, leading to prolonged suppression of acid output even after plasma concentrations fall. Onset of action is slower than that of H2‑receptor antagonists, but the degree of acid suppression is greater and more sustained.

Common adverse effects are generally mild and include headache, diarrhoea, constipation, nausea and abdominal pain. Longer‑term use has been associated with an increased risk of fractures, hypomagnesemia, vitamin B12 deficiency, and, in rare cases, Clostridioides difficile infection. Current guidelines recommend the lowest effective dose for the shortest necessary period, with periodic reassessment of the indication.

Research continues to evaluate the benefits of intermittent dosing, de‑prescribing strategies, and the role of PPITherapie in extra‑gastric diseases such as chronic cough and asthma, but evidence remains mixed. The overall consensus emphasizes evidence‑based prescribing and careful monitoring to balance therapeutic benefits against potential risks.