Abstract

ADJUNCTIVE USE OF ESOMEPRAZOLE IN THE TREATMENT OF PRE-ECLAMPSIA: A CASE REPORT AND LITERATURE REVIEW

Dr. Nicholas Oriaifo, Dr. S. E. Oriaifo*, Dr. C. Iruolagbe, Dr. (Mrs.) E. O. Okogbenin4 and Prof. J. Egbeifo

ABSTRACT

Faced with the absence of suitable assays and/or kits for predictive biomarkers, medical practitioners in poor resource settings may be emasculated by the unrelenting upwards prevalence of and uncertain forecast associated with the pre-eclampsia/eclampsia and fetal growth restriction disease spectrum. Low-birth weight and pre-eclampsia due to placental malaria, multiple pregnancy and malnutrition may be reactive oxygen species - and anti-angiogenic factors – dependent. Adjunctive esomeprazole promises to be a treatment regimen that may lead to cure for it has been found to attenuate the known pathophysiologic mechanisms responsible for pre-eclampsia and IUGR which may be imbalance between pro-angiogenic and anti-angiogenic factors. The proton pump inhibitor, esomeprazole, decreases the excessive secretion of the anti-angiogenic factors soluble fms-like tyrosine kinase-I (sFlt-I) and soluble endoglin from the placenta responsible for the hypertension, endothelial dysfunction, multiorgan injury and foetal growth restriction in preeclampsia. sFlt-I binds the pro-angiogenic placenta growth factor (PIGF) and vascular endothelial growth factor (VEGF), the circulating free forms of which are low in preeclampsia. Case report is of a 32-year old Nigerian housewife who showed significant reduction in blood pressure, proteinuria and pedal oedema with esomeprazole add-on to a regimen of methyl- dopa for severe preeclampsia. The combination significantly (P < 0.05) decreased the selected indices of uteroplacental insufficiency of proteinuria, serum uric acid levels, blood pressure, umbilical resistance index, pulsatility index and systolic/diastolic ratio. This report corroborates the accumulating pre-clinical data on the safety and efficacy of esomeprazole in the treatment of preeclampsia, a precursor of eclampsia.

Keywords: Preeclampsia, Eclampsia, sFlt-I, Esomeprazole.