From the Guidelines
Resolution of odynophagia with omeprazole indicates a possible diagnosis of proton pump inhibitor-responsive oesophageal eosinophilia (PPI-REE) or gastroesophageal reflux disease (GERD).
Key Points
- The resolution of odynophagia with omeprazole suggests that the symptoms may be related to acid reflux or eosinophilic esophagitis [ 1 ].
- PPI-REE is an entity that is challenging to distinguish from eosinophilic oesophagitis (EoE) and GERD, as it presents with similar clinical and histological features [ 1 ].
- A trial of proton pump inhibitors (PPIs) is often used to differentiate between GERD and EoE, but the response to PPIs does not always distinguish between the two conditions [ 1 ].
- The British Society of Gastroenterology recommends that omeprazole be given at a dose of 20 mg twice daily for at least 8-12 weeks to assess histological response [ 1 ].
- The American Gastroenterological Association recommends that diagnostic testing, including endoscopy and biopsy, be performed in patients with troublesome symptoms that have not responded to empirical PPI therapy [ 1 ].
Clinical Implications
- Clinicians should be aware of the possibility of PPI-REE and EoE in patients with odynophagia who respond to omeprazole.
- A thorough diagnostic evaluation, including endoscopy and biopsy, should be performed to rule out other conditions and to assess the response to PPI therapy.
- Patients with persistent symptoms despite PPI therapy should be referred to a gastroenterologist for further evaluation and management.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Resolution of Odynophagia with Omeprazole
- The resolution of odynophagia with omeprazole, a proton pump inhibitor (PPI), indicates that the patient's symptoms are likely related to acid-related disorders, such as gastroesophageal reflux disease (GERD) 2, 3, 4.
- Studies have shown that omeprazole is effective in reducing symptoms of GERD, including odynophagia, by suppressing acid secretion and allowing the esophagus to heal 2, 3, 4.
- The improvement in symptoms with omeprazole suggests that the patient's odynophagia is likely caused by acid reflux, rather than other factors such as mechanical or functional disorders 5, 4.
- The effectiveness of omeprazole in resolving odynophagia also suggests that the patient may have a significant component of acid-related disease, and that treatment with a PPI may be beneficial in managing their symptoms 2, 3, 6, 4.
Mechanism of Action
- Omeprazole works by inhibiting the proton pump in the stomach, reducing acid secretion and allowing the esophagus to heal 2, 3.
- The reduction in acid secretion with omeprazole also reduces the symptoms of GERD, including odynophagia, by decreasing the amount of acid that flows back up into the esophagus 2, 3, 4.
- The healing of the esophagus and reduction in symptoms with omeprazole can also reduce the risk of complications, such as stricture formation and dysphagia, in patients with GERD 3, 4.
Clinical Implications
- The resolution of odynophagia with omeprazole has important clinical implications, as it suggests that the patient's symptoms are likely related to acid-related disorders, and that treatment with a PPI may be beneficial in managing their symptoms 2, 3, 4.
- The effectiveness of omeprazole in resolving odynophagia also highlights the importance of considering acid-related disorders in the differential diagnosis of patients with dysphagia or odynophagia 5, 4.
- The use of omeprazole in patients with odynophagia may also reduce the need for further diagnostic testing or procedures, such as endoscopy or manometry, and may allow for more targeted and effective treatment of the underlying condition 2, 3, 4.