Physicians Practice - September 2008 - (Page 1) ADVERTISEMENT At least 25% of proton pumps may escape the effects of a PPI dose Not all proton pumps are active at any given time Proton pumps become active at various times throughout the day, usually in response to food.1 Following a meal, approximately 75% of pumps are activated to secrete acid.2,3 The body also regenerates pumps during the day, augmenting potential acid production.2 Proton pumps that are activated later in the day may escape inhibition PPIs have relatively short half-lives of approximately 1–2 hours. Any proton pumps activated after PPI concentrations fall below effective plasma levels may escape inhibition. At that time they may be free to secrete acid.2 Proton pumps are found in parietal cells and are in either active or inactive states Active Inactive PPIs can only inhibit active proton pumps Active acid secretion is required for PPIs to work. Therefore, only the proton pumps that are actively secreting acid may be inhibited.3 Many proton pumps are inactive following a meal At least 25% of proton pumps remain in their inactive state after a meal. These pumps can become activated later in the day.2 The clinical significance of this concept is unknown. References: 1. Del Valle J, Todisco A. Gastric secretion. In: Yamada T, Alpers DH, Kaplowitz N, Laine L, Owyang C, Powell DW, eds. Textbook of Gastroenterology. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:266-307. 2. Sachs G. Proton pump inhibitors and acid-related diseases. Pharmacotherapy. 1997;17:22-37. 3. Del Valle J, Chey WD, Scheiman JM. Acid peptic disorders. In: Yamada T, Alpers DH, Kaplowitz N, Laine L, Owyang C, Powell DW, eds. Textbook of Gastroenterology. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:1321-1376. ©2008 Takeda Pharmaceuticals North America, Inc. 2008-090-09231R1 7/08 Printed in U.S.A.
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