Proton Pump Inhibitor Therapy in Metabolic Syndrome and Gastroesophageal Reflux Disease: Expert Opinion and the Role of Rabeprazole
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Abstract
Aim: To analyse the efficacy of proton pump inhibitors (PPIs) in patients with metabolic syndrome (MetS) and provide guidance on selecting the most appropriate PPI to minimise drug interactions.
Background: Gastroesophageal reflux disease (GERD) and MetS share a common pathophysiological framework, with MetS increasing the risk of GERD. PPIs are critical for managing GERD, gastritis and peptic ulcers, especially in patients receiving anti-coagulants or anti-diabetics or in those with coronary heart disease. However, PPIs can inhibit hepatic cytochrome P450 (CYP450) enzymes, potentially leading to significant drug interactions. Thus, selecting PPIs with minimal CYP450 interactions is essential.
Review Results: This survey highlights the consensus among physicians regarding Rabeprazole’s efficacy and suitability as the preferred PPI for patients with MetS.
Discussion: Rabeprazole, which minimally inhibits CYP450 enzymes, is effective in gastroprotection and may be beneficial in improving glycaemic control in patients with diabetes, reducing blood pressure in individuals with hypertension and achieving positive outcomes in patients with cardiovascular disease, all while maintaining favourable safety profile. Due to its lack of CYP2C19 inhibition or induction, Rabeprazole may not interact with drugs such as Theophylline, Phenytoin, Warfarin or Diazepam. Additionally, it may reduce the risk of major adverse cardiovascular events when used in conjunction with Clopidogrel.
Clinical Significance: GERD and MetS are linked to each other. A PPI with minimal drug–drug interactions and pleiotropic benefits can be effective for GERD. Rabeprazole, due to its certain pleiotropic benefits and minimal drug–drug interaction can be recommended as the preferred PPI for managing GERD in patients with MetS.
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