During rounds today, I noticed that someone had changed an order for a proton pump inhibitor to an H2 blocker on one of our patients with short gut syndrome. The reason was some form of shortage, so they decided it was OK to switch.
So it was time for that discussion again.
Patients with intestinal failure secondary to substantial small bowel loss need proton pump inhibitors because they are in a state of hypergastrinemia, as gastrin is primarily metabolized in the small bowel.
Elevated gastrin levels cause an increase in the volume and acidity of gastric secretions, which results in an acidic environment in the small bowel. The increase in volume worsens the fluid and electrolyte balance which is already tenuous in patients with short gut. Additionally, the acidic environment in the small bowel exacerbates malabsorption by causing bile acids to precipitate (sabotage micelle formation) and by inactivating pancreatic enzymes.
He's back on his proton pump inhibitors.
Reference:
Kocoshis SA. Medical management of pediatric intestinal failure. Seminars in Pediatric Surgery (2010);19:20
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