提醒胃酸多,用Proton Pump Inhibitor (PPI)的网友

来源: yesterday*once*more 2020-11-12 06:25:13 [] [旧帖] [给我悄悄话] 本文已被阅读: 次 (20169 bytes)

昨晚朋友提醒的。我家因为偶尔使用抑制胃酸的药,就查了一些资料:Proton Pump Inhibitor (PPI)似乎能导致病毒易感染,或者病人病症更厉害。。。下面是一些文章的title:

“Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching”

Proton Pump Inhibitors are Risk Factors for Viral Infections: Even for COVID-19?

Heartburn medication tied to higher COVID-19 risk — but don’t panic

解释是胃酸本身就是人体的一道防线,高酸度能杀死病毒。我奇怪的是,抑制胃酸的另一类药物,Famotidine,怎么每问题呢?病毒流行早期甚至还被认为能减轻病毒带来的病症。。。下面这篇文章有总结和分析。信不信由你,科学还每发展到啥度能解释的地步:

Shttps://www.the-scientist.com/news-opinion/stomach-acid-heartburn-drugs-linked-with-covid-19-outcomes-68026tStomach Acid & Heartburn Drugs Linked with C

The uncertainty of the COVID-19 pandemic has made our stomachs churn, and now, evidence suggests that intense heartburn may be linked with worse symptoms of the disease. Some drugs that neutralize stomach acid, such as famotidine, which President Donald Trump is taking, are associated with reduced severity, but others, such as Prilosec, correlate with higher infection rates and risk of death, at least in patients hospitalized with SARS-CoV-2 infections.

“Everyone has some level of acid reflux,” says Helder Nakaya, a systems biologist at the University of São Paulo in Brazil who has been studying the link between stomach acid and SARS-CoV-2 infection. “But I want to be clear . . . we cannot claim that this increased risk of death would apply to everyone with reflux.” The link does suggest that stomach acid might be a factor that’s often overlooked when it comes to COVID-19, Nakaya says.

In a retrospective analysis posted on medRxiv of roughly 1,300 hospitalized COVID-19 patients, Nakaya and colleagues found that individuals taking proton-pump inhibitors, including Prilosec, had a two- to three-fold higher risk of death compared with hospitalized patients not taking those drugs. This observation falls in line with a study published in late August in the American Journal of Gastroenterology by doctors in the US that also found people taking a proton-pump inhibitor twice a day for acid reflux had higher odds of testing positive for SARS-CoV-2 compared with individuals taking that type of drug once a day or individuals who took a histamine-2 receptor blocker such as Pepcid AC. 

Proton-pump inhibitors “may undermine the gastric barrier to SARS-CoV-2 entry and reduce microbial diversity in the gut,” increasing patients’ risk getting COVID-19, the US-based team writes in its report.

Another retrospective analysis published online in Gastroenterology in May found that in a cohort of 1,620 hospitalized patients, proton-pump inhibitors had no relationship to the patients’ outcomes. Meanwhile, famotidine, which blocks the histamine-2 receptor on cells, correlated with a reduced risk of patients being intubated or dying from COVID-19. 

Prior to analyzing that larger dataset, the authors had heard anecdotal evidence that famotidine might make COVID-19 symptoms less severe, and they’d heard that a few in vitro experiments also backed up the idea, study coauthor Joseph Conigliaro, the division chief of general internal medicine in the Department of Medicine at Northwell Health in Manhasset, New York, tells The Scientist in an email. In April, Northwell partnered with Alchem Laboratories and launched a randomized clinical trial to test whether giving up to 360 milligrams of famotidine intravenously to COVID-19 patients would improve their health outcomes compared with patients who received standard of care treatment. The trial later came under fire with a government whistleblower complaint for being hastily approved with little evidence and for the high doses of the drug being used, according to the Associated Press. Still, Northwell’s research on famotidine continued.

“Neither the whistleblower complaint or the AP story had much of an effect on us. However, they are part of an overall trend to politicize Covid-19 clinical trials and prospective therapies that is deeply unfortunate,” Matthew Libassi, a spokesperson for the Feinstein Institutes for Medical Research, the research arm of Northwell, writes in an email to The Scientist. “That trend concerns us as it makes it harder to conduct medical science research.” 

Despite the pushback, additional evidence for famotidine’s role in fighting viruses has surfaced. A past study published in 1996 had shown that famotidine could reduce viral replication of HIV, and a more recent computational analysis published in May also suggested that the histamine blocker could have some antiviral properties—specifically, that it might inhibit a protease that processes proteins vital for SARS-CoV-2 replication.

The computational results offered “some biological plausibility” to the hypothesis that famotidine could reduce the severity of COVID-19, but “in the end I think the computational models do not tell the whole picture,” Conigliaro says. That’s why he and his colleagues conducted their retrospective study on patients admitted to the hospital between February 25 and April 13 (these patients were not part of Northwell’s clinical trial testing famotidine). Analysis of the data revealed a distinct difference in the overall health outcomes of the patients taking famotidine compared with patients not given the drug. (Why the patients were given famotidine is not clear, though some had a history of gastric reflux and were taking the medication prior to being admitted to the hospital.)

“I expected a difference, but not so pronounced,” Conigliaro says. “I was also surprised that doses as low as what was used is the retrospective study would work that well. We had anticipated that bigger doses would be needed.” In the study, some patients received up to 20 milligrams of famotidine per day for five days intravenously, while others received it orally; when used for acid reflux, patients can take as much as 160 milligrams four times a day. Those who got the drug in the hospital fared better than those who did not, the study found.  

Julian Abrams, a gastroenterologist at Columbia University Irving Medical Center-New York Presbyterian Hospital and a collaborator of Conigliaro, notes that the link between famotidine and reduced severity of COVID-19 is still only correlational at this point, but nevertheless warrants more attention.

Stomach acid and ACE2

Nakaya’s work offers a bit more insight into potential mechanisms. He and his team weren’t initially planning to look at the relationship between antacids and COVID-19 at all. Their project began as an offshoot of another one that Nakaya’s graduate student, Leandro Jimenez, had started. Jimenez had been analyzing the transcriptome data of patients with Barrett’s esophagus, a condition in which acid reflux causes damage to the lining of the esophagus. 

The data from biopsies and a gene expression repository revealed increased expression of the gene ACE2, which encodes a cell surface protein that SARS-CoV-2 uses to enter human cells, in individuals with Barrett’s esophagus compared with individuals who did not have the condition. That increased gene activity was tied to regulation of intracellular pH pathways, specifically, their enrichment. That connection suggests increased ACE2 expression is linked with lower pH inside cells, possibly a result of exposure to stomach acid. 

“And that raised a flag,” Nakaya says, which led his team to hypothesize that Barrett’s esophagus, as well as gastroesophageal reflux disease (GERD), may be a comorbidities of COVID-19 that hadn’t been identified before.

To test the link between stomach acid and SARS-CoV-2 infectivity, Nakaya’s team exposed human monocytes in cell culture to different pH conditions and then to SARS-CoV-2. The researchers used these immune cells because they are known to be susceptible to infection by the coronavirus, Nakaya says. Under normal oxygen levels, the cells in culture with a pH lower than 7.4 had a higher expression of ACE2 and also a higher viral load. The result indicates that intracellular pH may influence the ability of SARS-CoV-2 to infect cells and replicate within them.

But it wasn’t clear, says Nakaya, that the finding would have any clinical relevance, so the team dug into the medical records of patients in Manaus and São Paulo, Brazil, who had been hospitalized for COVID-19 and found that proton-pump inhibitors correlated with an increased risk of death. That association, Nakaya says, suggests that it might not be the drugs themselves that lead to worsening COVID-19 symptoms, but instead that the proton-pump inhibitors are, the team writes, “important markers of hidden comorbidities that involve the damage caused by the excess stomach acid in GI tissues.” In other words, the low pH that cells are dealing with—and that patients are trying to treat with a proton-pump inhibitor—might make the cells more vulnerable to SARS-CoV-2 infection.

The results, however, don’t explain why famotidine correlated with better outcomes in Conigliaro and Abrams’s study, supposing the drug is also used to suppress stomach acid. “We don’t think that stomach acid is the explanation for the findings,” says Abrams. “We really don’t know why we found what we did.”

The past work on HIV and the computational analysis suggest that famotidine works as an antiviral, and a study published today (October 7) also supports that idea. The research shows that ranitidine bismuth citrate, another histamine antagonist and antibiotic combo used to treat stomach acid, suppresses SARS-CoV-2 replication in infected golden Syrian hamsters and improves their virus-related pneumonia symptoms. But famotidine, Conigliaro says, may have benefits other than being antiviral; it may actually prevent patients’ immune systems from overreacting to a SARS-CoV-2 infection and causing a life-threatening cytokine storm. There’s some evidence for this from an observational study in which patients severely ill with COVID-19 were given a cocktail of histamine blockers, one of which was famotidine, and had better outcomes than did patients receiving the standard of care whose cases were reported elsewhere. Those data and other research “seem to suggest that the anti-histamine effect is what prevents patients from getting the cytokine storm,” Conigliaro explains, noting that cells with the histamine-2 receptor are in the lungs as well as the stomach. 

The results from those studies and his team’s work, he says, bolster the case for the clinical trial launched last spring to test famotidine as a treatment for COVID-19, results of which are still pending. The Department of Defense under the Discovery of Medical Countermeasures Against Novel Entities, or DOMANE, program is also studying famotidine as a COVID-19 treatment, according to Vanity Fair, and another famotidine trial in Bangladesh is also now recruiting patients. 

“Most people’s attention is shifting towards vaccines rather than treatments,” Abrams says, but “with President Trump having COVID, that brings to light again the issue of treatments, especially since he was getting famotidine.”

OVID-19 Outcomesomach Acid & Heartburn Drugs Linked with COVID-19 Outcomes

Stomach Acid & Heartburn Drugs Linked with COVID-19 Outcomes

所有跟帖: 

这些胃药归到PPI类别: -yesterday*once*more- 给 yesterday*once*more 发送悄悄话 (1977 bytes) () 11/12/2020 postreply 06:31:35

睡觉用个三角枕,头垫高点 -joshuamama- 给 joshuamama 发送悄悄话 joshuamama 的博客首页 (0 bytes) () 11/12/2020 postreply 06:35:24

我家人有过同样的问题,买了一个喉咙好多了 -joshuamama- 给 joshuamama 发送悄悄话 joshuamama 的博客首页 (0 bytes) () 11/12/2020 postreply 06:40:27

你也可以把床头抬高,我家就是把床垫床头都抬高了25度的样子 -9876543- 给 9876543 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:51:48

要注意点。反酸不是好事。。。 -yesterday*once*more- 给 yesterday*once*more 发送悄悄话 (242 bytes) () 11/12/2020 postreply 06:36:08

饭后吃几粒花生慢慢就好了,我的经验 -临风而眠- 给 临风而眠 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:40:17

熟的红皮花生,用油炒熟,再撒些盐,感觉效果更佳 -临风而眠- 给 临风而眠 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:45:31

吃生花生米,细细嚼,我家领导戒了酒又吃了几天花生,胃酸过多好了而且几年都没犯了 -9876543- 给 9876543 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:46:29

我吃煮的或生的,油炸或烤的上火,喉咙会另一种不舒服 -静非徒寂守99- 给 静非徒寂守99 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:48:08

我如果晚上吃炒炸烤的花生米,第二天起来嗓子会非常干。 -seattleWA- 给 seattleWA 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:53:46

别吃炸的,医生给的List上,油炸食品应该避免的 -9876543- 给 9876543 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:56:53

吃煮的吧,生的不好吃就生熟配着吃。生的效果好些 -静非徒寂守99- 给 静非徒寂守99 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:58:50

晚饭不吃甜食和太多碳水化合物,然后一把花生米 -静非徒寂守99- 给 静非徒寂守99 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:43:34

去做个胃镜,看看有没有胃溃炎。 -katies- 给 katies 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:42:45

我也有这个问题,胃镜喉镜都看过了,最后专家说是反酸。不知道不吃药能不能养好。 -seattleWA- 给 seattleWA 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:45:39

我家领导就养好了,好几年都没犯过 -9876543- 给 9876543 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:48:42

谢谢。我也吃生花生米试试。这个问题困扰我十几年了。 -seattleWA- 给 seattleWA 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:51:21

你吃酸的吗?西红柿一类的,巧克力啥的都要戒掉,不过好了还可以吃,比如我家的已经吃掉一大罐子巧克力了 -9876543- 给 9876543 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:53:04

我不怎么吃甜食水果的,主食也吃的少,肉蔬比较多。不知道为什么还老反酸 -seattleWA- 给 seattleWA 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:56:26

有压力,吃纤维高的蔬菜太多,比如红薯,会引发胃酸 -9876543- 给 9876543 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:58:05

我就不能碰红薯,一吃准反酸,不消化。 -katies- 给 katies 发送悄悄话 (71 bytes) () 11/12/2020 postreply 07:01:13

我是吃韭菜,红薯都没问题,领导很馋,偷我的红薯吃半个都不行,现在养好了胃,可以吃一个整个小红薯了 -9876543- 给 9876543 发送悄悄话 (0 bytes) () 11/12/2020 postreply 07:03:11

韭菜,我也不消化,偶尔吃点韭黄,如果实在想吃的话。 -katies- 给 katies 发送悄悄话 (0 bytes) () 11/12/2020 postreply 07:06:44

我也是。嗓子坏掉了,老有东西堵着的感觉。看了几次医生都说是因为反酸。我也不爱吃药。就一直这样。有不吃药的办法吗? -seattleWA- 给 seattleWA 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:43:52

见我下面的跟帖 -Baritoner- 给 Baritoner 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:52:11

食疗呢?我听说吃broccoliseed salad,有帮助。 -katies- 给 katies 发送悄悄话 (80 bytes) () 11/12/2020 postreply 06:52:50

可以考虑吃antaacid, Tums,就是钙片,顺便补钙。。。 -yesterday*once*more- 给 yesterday*once*more 发送悄悄话 (364 bytes) () 11/12/2020 postreply 07:07:32

我吃那种moringa seed,或者去超市买这种drumstick bean来吃,有助于减少胃酸。 -Baritoner- 给 Baritoner 发送悄悄话 (117 bytes) () 11/12/2020 postreply 06:34:38

这是你们老广的丝瓜啊。。。 -yesterday*once*more- 给 yesterday*once*more 发送悄悄话 (243 bytes) () 11/12/2020 postreply 06:37:45

不是。是印度人的菜,不是所有的超市都有的,只是在印度人多的地区,而且也是偶尔才有。 -Baritoner- 给 Baritoner 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:39:23

你说的这些都不好买到吧。 -seattleWA- 给 seattleWA 发送悄悄话 (0 bytes) () 11/12/2020 postreply 06:58:44

俺刚上大学时胃酸很多不舒服。吃根油条就感觉好很多。后来莫名其妙就好了,,, -k_lao- 给 k_lao 发送悄悄话 (0 bytes) () 11/12/2020 postreply 07:07:42

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