Gastric acid suppression in cats and dogs: are PPIs and H2 blockers indicated in a wide range of vomiting patients?
I’ll start by saying that we don’t have a whole lot of evidence on which to base an answer to that question. The root of trying to answer it is that it is my observation that omperazole, famotidine and ranitidine are widely used in general practice in cats and dogs with acute gastrointestinal disorders. And those alongside antibiotics, analgesics, fluids and anti-emetics in some cases.
It’s not so much that I know that I’m seeing a lot of adverse reactions; it’s more that it makes me a bit nervous using any medications without having a bit more of a handle on why we’re doing it. It’s a big and difficult subject but interesting to talk about!
There are scenarios where acid suppression seems undoubtedly sensible: known or likely oesophagitis or gastric/duodenal ulcers. I guess one could argue that oesophagitis is a potential complication in any patient with repeated vomiting. Nonetheless, my issue is more with acute gastro-entero-colitis and pancreatitis.
I started wondering whether the fact that we use these agents so widely had been taken from established human protocols.
So, acute pancreatitis….
Effects of proton pump inhibitor on outcomes of patients with severe acute pancreatitis based on a national administrative database.
How about IBD/chronic enteropathy…..
Gastric Acid Suppression Is Associated with an Increased Risk of Adverse Outcomes in Inflammatory Bowel Disease.
…Nope, not there either.
Or acute gastroenteritis?
Acid–suppression medications and bacterial gastroenteritis: a population-based cohort study.
The punchline of that one being ‘The results suggest that community prescribed acid-suppressing medications were associated with increased rates of C. difficile and Campylobacter positive gastroenteritis in both the community and hospital settings.’
Eek! maybe not the best idea there either 🙁 I suppose you could argue that acid suppression reduces defence against initial infection and may be less relevant in established cases. Maybe. Even so, there’s certainly no mention of acid suppression in recent review papers of management strategies for acute gastroenteritis in people.
I do believe that oesophagitis is an under-diagnosed problem in cat and dogs. Maybe one day someone will prove the benefit of prophylactic acid suppression in acute repeated vomiting in our patients. Who knows?
Potential adverse effects of omeprazole include vomiting, diarrhoea and nausea. Ranitidine is probably less of a problem in this respect….but then it may not actually reduce gastric acidity very effectively. That’s another whole subject which we have visited previously…