Download PDF
Zeitschrift für Orthomolekulare Medizin 2022; 20(01): 14-21
DOI: 10.1055/a-1743-6980
Wissen

Protonenpumpenhemmer (PPI): Mikronährstoff-Räuber mit nachhaltigen Nebenwirkungen (Teil 1)

Uwe Gröber
› Further Information
    Permissions and Reprints

Zusammenfassung

Die längerfristige Einnahme von Protonenpumpeninhibitoren (PPI) ist mit zahlreichen Risiken verbunden, daher ist der Einsatz der Säureblocker möglichst auf max. 8 Wochen zu begrenzen. Aufgrund der verringerten Magensäureproduktion unter PPI siedeln sich vermehrt pathogene Bakterien im Gastrointestinaltrakt an, es kommt zu verminderter Resorption und Utilisation von Mikronährstoffen wie Magnesium, Kalzium, Zink, Eisen und Vitamin B12. Eine Reihe von miteinander vernetzten Pathomechanismen erhöht das Osteoporose- bzw. Frakturrisiko deutlich. Erste Studien weisen darauf hin, dass die dauerhafte Blockade der Magensäure das Risiko für eine Infektion mit SARS-CoV-2 als auch die Schwere des Krankheitsverlaufs steigert. Die Verabreichung von PPI im 1. Trimenon der Schwangerschaft scheint nicht mit einem teratogenen Risiko verbunden zu sein, im Gegensatz zur Einnahme in den 4 Wochen vor der Konzeption. Die Einnahme während der Gravidität erhöht das Risiko für kindliches Asthma und Allergien.

Schlüsselwörter

Protonenpumpenhemmer (PPI) - Nebenwirkungen - Mikronährstoffe - Prazole - Osteoporoserisiko - Hypergastrinämie - Magnesiummangel - Eisen - Zink - Vitamin B12 - Sturzrisiko - Helicobacter pylori - Pneumonie - COVID-19 - Schwangerschaft - Geburtsdefekte - Asthma


Publication History

Article published online:
28 March 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Schwabe D, Paffrath W, Ludwig WD, Klauber J. Hrsg Arzneiverordnungsreport 2019. Berlin: Springer; 2019
    CrossrefGoogle Scholar
  • 2 Willems RPJ, van Dijk K, Ket JFC. et al. Evaluation of the Association Between Gastric Acid Suppression and Risk of Intestinal Colonization With Multidrug-Resistant Microorganisms: A Systematic Review and Meta-analysis. JAMA Intern Med 2020; 180: 561-571
    CrossrefPubMedGoogle Scholar
  • 3 Wei L, Ratnayake L, Phillips G. et al. Acid-suppression medications and bacterial gastroenteritis: a population-based cohort study. Br J Clin Pharmacol 2017; 83: 1298-1308
    CrossrefPubMedGoogle Scholar
  • 4 Liu J, Li X, Fan L. et al. Proton pump inhibitors therapy and risk of bone diseases: An update meta-analysis. Life Sci 2019; 218: 213-223
    CrossrefPubMedGoogle Scholar
  • 5 Kwok CS, Yeong JKY, Loke YK. Meta-analysis: risk of fractures with acid-suppressing medication. Bone 2011; 48: 768-776
    CrossrefPubMedGoogle Scholar
  • 6 Yu EW, Bauer SR, Bain PA, Bauer DC. Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am J Med 2011; 124: 519-526
    CrossrefPubMedGoogle Scholar
  • 7 Fraser LA, Leslie WD, Targownik LE. The effect of proton pump inhibitors on fracture risk: report from the Canadian Multicenter Osteoporosis Study. Osteoporos Int 2013; 24: 1161-1168
    CrossrefPubMedGoogle Scholar
  • 8 Cai D, Feng W, Jiang Q. Acid-suppressive medications and risk of fracture: an updated meta-analysis. Int J Clin Exp Med 2015; 8: 8893-8904
    PubMedGoogle Scholar
  • 9 Dachverband der Deutschsprachigen Wissenschaftlichen Osteologischen Gesellschaften (DVO): Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und bei Männern. Leitlinie 2017 https://www.awmf.org/uploads/tx_szleitlinien/183-001l_S3_Osteoporose-Prophylaxe-Diagnostik-Therapie_2019-02.pdf(Stand: 07.01.2022)
  • 10 Abramowitz J, Thakkar P, Isa A. et al. Adverse Event Reporting for Proton Pump Inhibitor Therapy: An Overview of Systematic Reviews. Otolaryngol Head Neck Surg 2016; 155: 547-554
    CrossrefPubMedGoogle Scholar
  • 11 Thong BKS, Ima-Nirwana S, Chin KY. et al. Proton Pump Inhibitors and Fracture Risk: A Review of Current Evidence and Mechanisms Involved. Int J Environ Res Public Health 2019; 16: 1571
    CrossrefPubMedGoogle Scholar
  • 12 Lewis JR, Barre D, Zhu K. et al. Long-term proton pump inhibitor therapy and falls and fractures in elderly women: a prospective cohort study. J Bone Miner Res 2014; 29: 2489-2497
    CrossrefPubMedGoogle Scholar
  • 13 Menhali AA, Keeley TM, Demitrack ES, Samuelson LC. Gastrin induces parathyroid hormone-like hormone expression in gastric parietal cells. Am J Physiol Gastrointest Liver Physiol 2017; 312: G649-G657
    CrossrefPubMedGoogle Scholar
  • 14 Hinson AM, Wilkerson BM, Rothman-Fitts I. et al. Hyperparathyroidism associated with long-term proton pump inhibitors independent of concurrent bisphosphonate therapy in elderly adults. J Am Geriatr Soc 2015; 63: 2070-2073
    CrossrefPubMedGoogle Scholar
  • 15 Yang SD, Chen Q, Wie HK. et al. Bone fracture and the interaction between bisphosphonates and proton pump inhibitors: a meta-analysis. Int J Clin Exp Med 2015; 8: 4899-4910
    PubMedGoogle Scholar
  • 16 Bartl R, von Tresckow E. Interactions of proton pump inhibitors with oral bisphosphonates and fracture risk. Dtsch Med Wochenschr 2012; 137: 804-805
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Inaba M, Okuno S, Imanishi Y. et al. Magnesium deficiency enhances secretion of parathyroid hormone in normal and 5/6-nephrectomized uremic rats. J Endocrinol Invest 1992; 15: 135-142
    PubMedGoogle Scholar
  • 18 Vetter T, Lohse MJ. Magnesium and the parathyroid. Curr Opin Nephrol Hypertens 2002; 11: 403-410
    CrossrefPubMedGoogle Scholar
  • 19 Na D, Tao G, Shu-Ying L. et al. Association between hypomagnesemia and severity of primary hyperparathyroidism: a retrospective study. BMC Endocr Disord 2021; 21: 170
    CrossrefPubMedGoogle Scholar
  • 20 Douwes RM, Gome-Neto AW, Eisenga MF. et al. Chronic Use of Proton-Pump Inhibitors and Iron Status in Renal Transplant Recipients. J Clin Med 2019; 8: 1382
    CrossrefPubMedGoogle Scholar
  • 21 Gröber U, Kisters K, Schmidt J. Important drug-micronutrient interactions: A selection for clinical practice. Crit Rev Food Sci Nutr 2018; 23: 1-19 DOI: 10.1080/10408398.2018.1522613.
    CrossrefPubMedGoogle Scholar
  • 22 Hamano H, Niimura T, Horinouchi Y. et al. Proton pump inhibitors block iron absorption through direct regulation of hepcidin via the aryl hydrocarbon receptor-mediated pathway. Toxicol Lett 2020; 318: 86-91
    CrossrefPubMedGoogle Scholar
  • 23 Jones G, Prosser DE, Kaufmann M. Cytochrome P450-mediated metabolism of vitamin D. J Lipid Res 2014; 55: 13-31
    CrossrefPubMedGoogle Scholar
  • 24 Toxqui L, Vaquero MP. Chronic iron deficiency as an emerging risk factor for osteoporosis: a hypothesis. Nutrients 2015; 7: 2324-2344
    CrossrefPubMedGoogle Scholar
  • 25 Heldenberg D, Tenenbaum G, Weisman Y. Effect of iron on serum 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D concentrations. Am J Clin Nutr 1992; 56: 533-536
    CrossrefPubMedGoogle Scholar
  • 26 Katsumata S, Katsumata R, Matsumoto N. et al. Iron deficiency decreases renal 25-hydroxyvitamin D3-1α-hydroxylase activity and bone formation in rats. BMC Nutrition 2016; 2: 33
    CrossrefGoogle Scholar
  • 27 Gröber U, Holick MF. Vitamin D – die Heilkraft des Sonnenvitamins. 4., aktual. u. erw. Aufl. Stuttgart: Wissenschaftliche Verlagsgesellschaft; 2020
    Google Scholar
  • 28 Farrell CP, Morgan M, Rudolph DS. Proton Pump Inhibitors Interfere With Zinc Absorption and Zinc Body Stores. Gastroenterology Res 2011; 4: 243-251
    PubMedGoogle Scholar
  • 29 Gröber U, Kisters K, Schmidt J. Neuroenhancement with Vitamin B12 – Underestimated Neurological Significance. Nutrients 2013; 5: 5031-5045
    CrossrefPubMedGoogle Scholar
  • 30 Giuliano C, Wilhelm SM, Kale-Pradhan P. et al. Are proton pump inhibitors associated with the development of community-acquired pneumonia? A meta-analysis. Expert Rev Clin Pharmacol 2012; 5: 337-344
    CrossrefPubMedGoogle Scholar
  • 31 Filion KB. Proton pump inhibitors and community acquired pneumonia. BMJ 2016; 355: i6041
    CrossrefPubMedGoogle Scholar
  • 32 Lambert AA, Lam JO, Ugarte-Gik C. et al. Risk of Community-Acquired Pneumonia with Outpatient Proton-Pump Inhibitor Therapy: A Systematic Review and Meta-Analysis. PLoSOne 2015; 10: e0128004
    CrossrefPubMedGoogle Scholar
  • 33 Almario CV, Chey WD, Spiegel BMR. Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors. Am J Gastroenterol 2020; 115: 1707-1715
    CrossrefPubMedGoogle Scholar
  • 34 Lee SW, Ha EK, Yeniova AÖ. et al. Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching. Gut 2021; 70: 76-84
    CrossrefPubMedGoogle Scholar
  • 35 Toubasi AA, AbuAnzeh RB, Khraisat BR. et al. Proton pump inhibitors current use and the risk of Coronavirus Infectious Disease 2019 development and its related mortality: Meta Analysis. Arch Med Res 2021; 52: 656-659
    CrossrefPubMedGoogle Scholar
  • 36 Ramachandran P, Perisetti A, Gajedran M. et al. Pre-hospitalization proton pump inhibitor use and clinical outcomes in COVID-19. Eur J Gastroenterol Hepatol 2022; 34: 137-141
    CrossrefPubMedGoogle Scholar
  • 37 Pasternak B, Hvii A. Use of proton-pump inhibitors in early pregnancy and the risk of birth defects. NEJM 2010; 363: 2114-2123
    CrossrefPubMedGoogle Scholar
  • 38 Devine RE, McCleary N, Sheikh A, Nwaru BI. Acid-suppressive medications during pregnancy and risk of asthma and allergy in children: A systematic review and meta-analysis. J Allergy Clin Immunol 2017; 139: 1985-1988
    CrossrefPubMedGoogle Scholar
  • 39 Wang YH, Wintzell V, Ludvigsson JF. et al. Association Between Proton Pump Inhibitor Use and Risk of Asthma in Children. JAMA Pediatr 2021; 175: 394-403
    CrossrefPubMedGoogle Scholar