The Benefits and Risks of PPI Use in H. Pylori Associated Peptic Ulcer Disease

Helicobacter pylori (H. pylori) infection is one of the most common causative factors of peptic ulcers, which may affect the stomach and the duodenum. Proton pump inhibitors (PPIs) have become a key ingredient of H. pylori-associated ulcers due to their highly acid-suppressive properties. Numerous clinical trials have proved that PPIs have a beneficial effect on the ulcer healing process in those with H. pylori infection. PPIs are acid pump inhibitors that irreversibly inhibit the H+/K+ ATPase proton pump in gastric parietal cells. Through this mechanism, PPIs reduce the secretion of gastric acid, allowing for a conducive environment that is favorable for ulcer healing. Meta-analyses have repeatedly shown that triple therapy with PPI (proton pump inhibitor) achieves higher ulcer healing rates compared to antibiotics therapy alone, which again stresses the synergistic effect of acid suppression and H. pylori eradication. PPI, in ulcer healing, remains indispensable, however, their effects on the regimen for eradication of H. pylori needs to be considered. PPIs are commonly used as one of the three main components of the standard triple therapy regimen in addition to antibiotics. Nevertheless, the risk of affecting the efficiency of H. pylori eradication using PPIs has been raised. Research may suggest that PPI use can decrease pH in the stomach, thereby compromising the action of antibiotics against H. pylori. Despite their efficacy, PPIs are associated with various risks and adverse effects. Long-term PPI use has been linked to an increased risk of enteric infections, including Clostridioides difficile-associated diarrhea, potentially attributable to altered gut microbiota and reduced gastric acidity. This literature review will examine PPI in the context of H. pylori infection, its efficacy in the treatment of ulcers, and related risks.