Features of the Diagnosis and Treatment of Acid-Related Disease in Patients with Diabetes Mellitus


  • S.M. Tkach Ukrainian Scientific and Practical Centre for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Healthcare of Ukraine, Kyiv




peptic ulcer disease, gastroesophageal reflux disease, eradication of H.pylori, diabetes mellitus, pantoprazole


The article considers the problem of the combined course of acid-related disorder of the gastrointestinal tract and diabetes mellitus (DM). The attention is paid to the fact that in most cases the treatment of gastroesophageal reflux disease and peptic ulcers in patients with diabetes mellitus should be carried out not as a proton pump inhibitor monotherapy, but as a comprehensive and differentiated treatment, taking into account etiological and pathogenetic features of the disease. When choosing the components of triple or quadruple therapy for the eradication of H.pylori in patients with DM among the group of proton pump inhibitors, it is desirable to give preference to pantoprazole (Zovanta). Pantoprazole does not interact with clarithromycin — basic antibiotic of H.pylori therapy. H.pylori therapy based on pantoprazole reduces the likelihood of side effects and increases the effectiveness of treatment.


Алексеенко С.А., Гордиенко С.А., Коротун В.М., Никонов Е.Л. Сравнительная эффективность различных схем антихеликобактерной терапии у больных сахарным диабетом 2-го типа // Рос. журн. гастроэнтерол., гепатол. и колопроктол. — 2001. — № 2 (Прил. 13). — ​С. 10-12.

Зиннатуллин М.Р., Циммерман Я.С., Трусов В.В. Сахарный диабет и язвенная болезнь // Экспериментальная и клиническая гастроэнтерология. — 2003. — № 5. — ​С. 17-24.

Колесникова Е.В. Диабетическая гастропатия: современный взгляд на этиопатогенез, диагностику и лечение // Здоровье Украины. — 2007. — № 7/1. — ​С. 62-63.

Федорченко Ю.Л., Коблова Н.М., Обухова Г.Г. Особенности течения язвенной болезни желудка и двенадцатиперстной кишки у больных сахарным диабетом // Врач. — 2001. — № 7. — ​С. 28-30.

Abraham N.S., Hlatky M.A., Antman E.M. et al. ​ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. A report of the American college of cardiology foundation task force on expert consensus documents // J. Am. Coll. Cardiol. — 2010. — 56 (24). — 2051-2066.

Banerjee S., Weideman R.A., Weideman M.W. et al. Effect of concomitant use of clopidogrel and proton pump inhibitors after percutaneous coronary intervention // Am. J. Cardiol. — 2011. — 107. — 871-878.

American Diabetic Association. Diagnosis and classification of diabetes mellitus // Diabetes Care. — 2009. — 32 (Suppl.). — ​S62-267.

Anastasios R., Goritsas C, Paramihail C. et al. Helicobacter pylory infection in diabetic patients: prevalence and endoscopic findings // Eur. J. Int. Med. — 2002. — ​V. 13 (6). — ​P. 376-379.

Emery M.G., Fisher J.M., Chien J.Y. et al. CYP2E1 activity before andafter weight loss in morbidly obese subjects with nonalcoholicfatty liver disease // Hepatology. — 2003. — 38. — 428-435.

FDA reminder to avoid concomitant use of Plavix (clopidogrel) and omeprazole; www.fda.gov/Drugs/DrugSafety/ucm231161. htm

Fitton A., Wiseman L. Pantoprazole. A review of its pharmacological properties and therapeutic use in acid-related disorders // Drugs. — 1996. — 51, 3. — 460-482.

Hagymási K., Müllner K., Herszényi L., Tulassay Z. Update on the pharmacogenomics of proton pump inhibitors // Pharmacogenomics. — 2011. — 12 (6). — 873-888.

Johnson D.A. Concomitant use of PPIs and antiplatelet therapy // Gastroenterol., Hepatol. — 2011. — 7. — 7-10.

Kotlyar M., Carson S.W. Effects of obesity on the cytochrome P450 enzyme system // Int. J. Clin. Pharmacol. Ther. — 1999. — 37. — 8-19.

Kromer W., Horbach S., Luhmann R. Relative efficacies of gastric proton pump inhibitors: their clinical and pharmacological basis // Pharmacology. — 1999. — 59. — 57-77.

Kwok C.S., Loke Y.K. Effects of proton pump inhibitors on platelet function in patients receiving clopidogrel: a systematic review // Drug Saf. — 2012. — 35. — 127-139.

Leclercq I., Horsmans Y., Desager J.P. et al. Reduction in hepaticcytochrome P‑450 is correlated to the degree of liver fat contentin animal models of steatosis in the absence of inflammation // J. Hepatol. — 1998. — 28. — 410-416.

Li X.-Q., Andersson T.B., Ahlstrom M., Weidolf L. Comparison of inhibitory effects of the proton pump-inhibiting drugs omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole on human cytochrome P450 activities // Drug Metab. Dis. — 2004. — 32 (8). — 821-827.

Ogawa R., Echizen H. Drug-drug interaction profiles of proton pump inhibitors // Clin. Pharmacokinet. — 2010. — 49 (8). — 509-533.

Steinijans V., Huber R., Hartmann M. et al. Lack of pantoprazole drug interactions in man: an updated review // Int. J. Clin. Pharmacol. Ther. — 1996. — 34 (1 Suppl.). — ​S31-S50.

Trifiro G., Corrao S., Alacqua M. et al. Interaction risk with proton pump inhibitors in general practice: significant disagreement between different drug-related information sources // Br. J. Clin. Pharmacol. — 2006. — 62 (5). — 582-590.

Xia H.H.-X., Talley N.J. et al. Helicobacter pylory infection is not associated with diabetes mellitus, nor with upper gastrointestinal symptoms in diabetes mellitus // Am. J. Gastroenterol. — 2001. — ​V. 96 (4). — ​P. 1039-1046.

Wrighton S.A., Thummel K. CYP3A // Levy R.H., Thummel K.E., Trager W.F., eds. Metabolic drug interactions, chapter 10. — ​Philadelphia: Lippincott Williams &Wilkins, 2000.



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