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Does long-term medication with a proton pump inhibitor induce a tolerance to H2 receptor antagonist?

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Abstract

Background

Previous reports suggest that complete tolerance to H2 receptor antagonists (H2RAs) in patients with regular H2RA medication may be due to hypergastrinemia-increased histamine synthesis or upregulation of H2 receptors. As proton pump inhibitors (PPIs) have been reported to induce hypergastrinemia (similar to H2RAs), patients receiving long-term medication with PPIs may show tolerance to preanesthetic H2RA. Therefore, we studied the efficacy of an H2RA, roxatidine, in patients receiving long-term PPI medication.

Methods

Effects of H2RA in 15 surgical patients receiving a regular PPI for more than 4 weeks (PPI+H2RA group) were compared with those in 30 patients not receiving regular PPIs or H2RAs (None+H2RA group and None+None group, n = 15 each). Oral roxatidine was given to both PPI+H2RA and None+H2RA group patients as an anesthetic premedication, while it was not given to None+None group patients. Gastric volume and pH were measured after induction of anesthesia.

Results

Gastric pH and volume (ml) in the PPI+H2RA group (5.79 ± 1.61 and 9.1 ± 16.7, respectively) were both similar to those in the None+H2RA group (5.54 ± 2.20 and 9.7 ± 10.8, respectively) but were significantly higher (gastric pH) and lower (volume) than in the None+None group (2.29 ± 1.84 and 29.3 ± 22.8, respectively, P < 0.01).

Conclusions

These data suggest that long-term PPI medication may not induce a tolerance to H2RAs.

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Authors and Affiliations

  1. Department of Anesthesiology, University of Hirosaki School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8563, Japan

    Hiroshi Hashimoto, Tetsuya Kushikata, Mihoko Kudo & Kazuyoshi Hirota

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  1. Hiroshi Hashimoto
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  2. Tetsuya Kushikata
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  3. Mihoko Kudo
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  4. Kazuyoshi Hirota
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Hashimoto, H., Kushikata, T., Kudo, M. et al. Does long-term medication with a proton pump inhibitor induce a tolerance to H2 receptor antagonist?. J Gastroenterol 42, 275–278 (2007). https://doi.org/10.1007/s00535-006-1946-3

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  • DOI: https://doi.org/10.1007/s00535-006-1946-3

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