The proton pump inhibitors (PPIs) lansoprazole (LPZ) and omeprazole (OPZ) have been widely used for more than 20 years in
the treatment of acid-related diseases such as gastro-duodenal ulcers and reflux esophagitis. Both LPZ and OPZ are derivatives of 2-[(2-
pyridylmethyl)sulfinyl]-1H-benzimidazole, but LPZ has a trifluoroethoxy group in the molecule which seems to provide unique pharmacological
properties in addition to its anti-secretory effect. For example, the anti-secretory effect of LPZ in rats was roughly 2 times
greater than that of OPZ but the anti-ulcer effects were more than 10 times stronger than those of OPZ in rat models of reflux esophagitis,
indomethacin-induced gastric antral ulcers and mepirizole-induced duodenal ulcers. It has also been reported that LPZ has acidindependent
protective effects on the gastrointestinal mucosa, anti-inflammatory effects, and anti-bacterial effects on Helicobacter pylori.
In contrast, recent advances in endoscopy have revealed that non-steroidal anti-inflammatory drugs (NSAIDs) often cause ulcers not only
in the stomach and duodenum, but also in the small intestine in humans. Anti-secretory drugs such as PPIs and histamine H2-receptor antagonists
(H2-RAs) are commonly used for the treatment of upper gastrointestinal mucosal lesions induced by NSAIDs. However, the effects
of these drugs on NSAID-induced small intestinal lesions are still not fully understood. In this article, both a brief history of the discovery
of LPZ and the unique pharmacological properties of LPZ independent from its anti-secretory action are reviewed, and the effects
of PPIs and H2-RAs on NSAID-induced small intestinal lesions are discussed.
Keywords: Helicobacter pylori, histamine H2-receptor antagonist, indomethacin, lansoprazole, NSAID, omeprazole, proton pump inhibitor, small intestinal ulcer, gastro-duodenal ulcers, reflux esophagitis
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