Omeprazole

Article Abstract:

A review is presented of the pharmacology and effectiveness of omeprazole, a drug that inhibits the secretion of stomach acid. Although omeprazole is widely used in some countries, in the US it is prescribed only on a short-term basis for reflux esophagitis (inflammation of the esophagus due to the entry of acid-containing stomach contents) and for Zollinger-Ellison syndrome (a condition in which tumors are formed that secrete gastrin, a hormone that stimulates the secretion of stomach acid). The drug works by inhibiting a ''pump,'' the enzyme H+/K+-ATPase that moves protons across the parietal cell membrane (the cell type that produces acid). The pharmacokinetics and metabolism of omeprazole are explained. Its effectiveness and safety in treating duodenal ulcer (ulcer of the first part of the small intestine), gastric (stomach) ulcer, reflux esophagitis, and Zollinger-Ellison syndrome are reviewed. Only patients with the latter disorder have taken omeprazole for more than a few weeks; it has been prescribed for more than 19,000 people in the US in clinical trials since 1983. Evidence from animal studies has suggested the drug may cause elevated levels of gastrin in the blood and a type of hormone-secreting tumor (carcinoid). Results from studies of these side effects in humans are reported; it is likely that serious side effects due to omeprazole are only associated with long-term use. This drug, used on a short-term basis, is safe and effective for treating disorders of hyperacidity. It does not offer advantages over H2-receptor antagonists (commonly used agents that block the effects of histamine, which stimulates acid secretion) for treating duodenal or gastric ulcers. However, since Zollinger-Ellison syndrome and reflux esophagitis (against which it is superior to H2-receptor antagonists) tend to recur after drug use is discontinued, questions concerning the long-term safety of omeprazole should be resolved. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects

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Surgery for reflux disease - reflections of a gastroenterologist

Article Abstract:

Most patients with gastroesophageal reflux disease require long-term care and treatment. Gastroesophageal reflux disease is a dysfunction of the esophagus that causes regurgitation of acidic juices from the stomach. Individuals with this condition suffer from heartburn, and those with a more severe form of the disease can have inflammation and ulceration of the esophagus. Patients with mild gastroesophageal reflux disease can benefit from lifestyle modifications such as changes in their diets, and sleeping with their head in an elevated position to prevent regurgitation of acidic juices. Individuals who have frequent heartburn and inflammation of the esophagus can benefit from drug therapy. Anti-reflux surgery is an alternative treatment for patients with severe symptoms and ulceration of the esophagus. Patients should have a thorough evaluation of their esophageal function before undergoing surgery. Patients can have several different types of anti-reflex surgeries, and surgery should be performed by an experienced surgeon. Most patients who have anti-reflux surgery have good to excellent outcomes.

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Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication

Article Abstract:

People with Helicobacter pylori (H. pylori) infection and reflux esophagitis who are treated with omeprazole appear to more likely to develop atrophic gastritis than those treated with fundoplication. H. pylori infection causes chronic gastritis, which can lead to atrophic gastritis, a condition that precedes stomach cancer in many patients. It is possible that gastritis progresses faster in people receiving proton-pump inhibitors, such as omeprazole. An average five-year follow up of patients with and without H. pylori infection who had either received omeprazole as a treatment for reflux esophagitis or underwent the surgical procedure fundoplication was conducted. No new cases of atrophic gastritis developed in the group that underwent surgery, while 20 cases developed in the group that received omeprazole. Of these 20 cases, 18 occured in patients with H. pylori infection at the time of treatment.

Evaluation, Risk factors, Helicobacter infections, Stomach cancer, Gastritis, Fundoplication

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