What is the role of omeprazole (Proton Pump Inhibitor, PPI)?

From the Guidelines

Omeprazole PPI therapy is effective in maintaining remission in patients with eosinophilic oesophagitis (EoE) who have achieved histological response, with 70.1% to 81% of patients exhibiting long-term histological remission on maintenance treatment 1.

Key Points

• The British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines recommend maintenance PPI therapy as a long-term treatment in patients with EoE who are in clinical and histological remission 1.
• A prospective study found that 57 children who responded to an initial 8-week course of PPI treatment (omeprazole 1 mg/kg two times per day) exhibited 70.1% long-term histological remission on maintenance treatment for 12 months 1.
• A retrospective cohort study of 75 PPI responsive patients observed sustained histological remission in 73% and clinical remission in 100% on maintenance PPI therapy for at least 12 months 1.

Treatment Considerations

• The effectiveness of PPIs in maintaining disease remission is closely related to the degree of response seen with initial treatment 1.
• There are no published studies of maintenance treatment of more than 12 months duration, but the high risk of relapse on stopping therapy suggests that maintenance PPI therapy can be considered as a long-term treatment in patients with EoE who are in clinical and histological remission 1.
• The standard dose of omeprazole for EoE is typically 1 mg/kg two times per day (up to 40 mg two times per day) 1.

From the FDA Drug Label

Omeprazole belongs to a class of antisecretory compounds, the substituted benzimidazoles, that suppress gastric acid secretion by specific inhibition of the H+/K+ ATPase enzyme system at the secretory surface of the gastric parietal cell Omeprazole delayed-release capsules are a prescription medicine called a proton pump inhibitor (PPI). Omeprazole delayed-release capsules reduce the amount of acid in your stomach.

Omeprazole is a Proton Pump Inhibitor (PPI): Omeprazole works by inhibiting the H+/K+ ATPase enzyme system, which reduces gastric acid secretion.

• Mechanism of Action: Omeprazole suppresses gastric acid secretion by specific inhibition of the H+/K+ ATPase enzyme system at the secretory surface of the gastric parietal cell.
• Use: Omeprazole delayed-release capsules are used to reduce the amount of acid in the stomach for various conditions, including duodenal ulcers, gastroesophageal reflux disease (GERD), and Zollinger-Ellison Syndrome. 2 2

From the Research

Omeprazole PPI

• Omeprazole is a type of proton pump inhibitor (PPI) used to manage gastric acid-related diseases in adults 3.
• PPIs, such as esomeprazole, have been shown to be effective in the treatment of reflux oesophagitis, gastro-oesophageal reflux disease (GORD), and the prevention and healing of NSAID-associated gastric ulcer disease 3.
• The relationship between Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease (GERD) has been studied, and current evidence suggests that there is no relationship between GERD and H. pylori presence 4, 5, 6, 7.
• H. pylori eradication is recommended for patients with peptic ulcer disease, but not for those with GERD, unless they require long-term PPI therapy 5, 7.
• PPIs, such as omeprazole, are often used in combination with antibiotics to eradicate H. pylori infection, and the first-line recommended treatment is typically a 1-week course of triple therapy with a PPI, clarithromycin, and amoxicillin or metronidazole 6, 7.

Helicobacter pylori and PPIs

• H. pylori infection is a major pathogen inducing gastric mucosal inflammation and causing dysregulation of normal acid inhibitory regulatory mechanisms 4.
• Eradication of H. pylori leads to healing of gastric mucosal inflammation, healing of peptic ulcers, prevention of new peptic ulcers, and prevention or reduction in gastric cancer risk 4, 6.
• Long-term use of PPIs may have an impact on the development of atrophy and/or intestinal metaplasia in H. pylori positive patients, and therefore, H. pylori eradication is recommended in patients who require long-term PPI therapy 5, 7.

Treatment Options

• Esomeprazole, a single optical isomer PPI, has been shown to be effective in the management of GORD, NSAID-associated gastric ulcer disease, and H. pylori eradication 3.
• The choice of treatment for H. pylori infection and GERD should be based on current evidence-based recommendations, taking into account the potential benefits and risks of PPI therapy and H. pylori eradication 7.