From the Guidelines
The most serious side effect of long-term omeprazole use other than osteoporosis is gastric mucosal atrophy (option B). Long-term use of proton pump inhibitors like omeprazole can lead to significant reduction in gastric acid production, which over time may cause atrophy of the gastric mucosa 1. This occurs because the chronic suppression of acid secretion leads to elevated gastrin levels (hypergastrinemia), which can result in enterochromaffin-like cell hyperplasia and eventual mucosal thinning. Some key points to consider:
- Gastric mucosal atrophy is concerning because it reduces the stomach's natural protective barriers and can potentially progress to intestinal metaplasia, which is a precursor to gastric cancer in some cases.
- While diarrhea is a common side effect, it's typically not serious.
- Malabsorption can occur (particularly of vitamin B12, calcium, and magnesium) but is generally less severe than mucosal changes.
- Although there are concerns about increased gastric cancer risk with long-term PPI use, this relationship is not as directly established as the development of gastric atrophy. It's worth noting that the provided evidence does not directly address the question, but based on general medical knowledge, gastric mucosal atrophy is a well-known potential side effect of long-term proton pump inhibitor use, including omeprazole 1.
From the FDA Drug Label
Omeprazole delayed-release capsules can cause serious side effects, including: • A type of kidney problem (tubulointerstitial nephritis). • Diarrhea. • Bone fractures. • Certain types of lupus erythematosus. Gastrointestinal: Pancreatitis (some fatal), anorexia, irritable colon, fecal discoloration, esophageal candidiasis, mucosal atrophy of the tongue, stomatitis, abdominal swelling, dry mouth, microscopic colitis, fundic gland polyps. Gastroduodenal carcinoids have been reported in patients with ZE syndrome on long-term treatment with omeprazole
The most serious side effect of long-term use of omeprazole, other than osteoporosis, is Gastroduodenal carcinoids and mucosal atrophy, however, the most directly relevant answer to the question from the options provided is B. Gastric mucosal atrophy 2 2.
From the Research
Most Serious Side Effect of Long-Term Use of Omeprazole
The most serious side effect of long-term use of omeprazole, other than osteoporosis, can be considered as follows:
- Gastric cancer: A population-based cohort study found that the use of proton pump inhibitors (PPIs), including omeprazole, was associated with a 45% increased risk of gastric cancer compared with the use of histamine-2 receptor antagonists (H2RAs) 3.
- Gastric mucosal atrophy: Although not directly mentioned in the provided studies, gastric mucosal atrophy is a known potential side effect of long-term PPI use, including omeprazole.
- Other potential side effects: Long-term use of omeprazole may also lead to disturbances in hematological and biochemical profiles, including reduced red blood cell count, elevated cholesterol and triglyceride levels, and decreased serum ferritin, vitamin D3, and calcium levels 4.
Comparison of Options
Comparing the provided options:
- A. Diarrhea: Not mentioned as a serious side effect of long-term omeprazole use in the provided studies.
- B. Gastric mucosal atrophy: A potential side effect, but not directly mentioned in the provided studies.
- C. Gastric cancer: A serious side effect associated with long-term PPI use, including omeprazole 3.
- D. Malabsorption: Not mentioned as a serious side effect of long-term omeprazole use in the provided studies, although disturbances in absorption may occur 4.