What are the effects of long-term Omeprazole (omeprazole) use on esophageal stricture after balloon dilation procedure?

From the Guidelines

Long-term omeprazole use is generally recommended for patients with esophageal strictures after balloon dilation procedures to prevent stricture reformation and reduce the risk of complications. The typical regimen involves taking omeprazole 20-40 mg once daily, with some patients requiring twice-daily dosing depending on symptom severity, as suggested by guidelines on oesophageal dilatation in clinical practice 1. This medication should be taken 30-60 minutes before breakfast (and dinner if twice daily) for optimal acid suppression. Long-term therapy is often necessary as esophageal strictures tend to recur, with many patients requiring continuous treatment for years or even indefinitely. Omeprazole works by reducing stomach acid production, which helps prevent acid reflux that can irritate the esophagus and contribute to stricture reformation. This acid suppression allows the dilated esophagus to heal properly and reduces inflammation that could lead to re-narrowing.

Some key points to consider when using omeprazole for esophageal strictures include:

• The importance of regular follow-up with a gastroenterologist to monitor for potential side effects of long-term PPI use, such as vitamin B12 deficiency, magnesium deficiency, or increased risk of bone fractures, as highlighted in guidelines on the use of oesophageal dilatation in clinical practice 1.
• The need to periodically attempt to reduce the dose to the lowest effective level that controls symptoms while minimizing potential long-term risks, as suggested by studies on the outcomes and follow-up of oesophageal dilatation 1.
• The potential for complications, such as perforation, pulmonary aspiration, and bleeding, which can occur with oesophageal dilatation, and the importance of prompt recognition and treatment, as discussed in guidelines on the complications of oesophageal dilatation 1.

Overall, the use of omeprazole in patients with esophageal strictures after balloon dilation procedures is supported by guidelines and studies, including those published in the journal Gut 1, and is an important part of managing these patients to prevent stricture reformation and reduce the risk of complications.

From the FDA Drug Label

The course of Barrett’s esophagus in 106 patients was evaluated in a U. S. double-blind controlled study of omeprazole 40 mg twice daily for 12 months followed by 20 mg twice daily for 12 months or ranitidine 300 mg twice daily for 24 months. No clinically significant impact on Barrett’s mucosa by antisecretory therapy was observed. Although neosquamous epithelium developed during antisecretory therapy, complete elimination of Barrett’s mucosa was not achieved

The FDA drug label does not answer the question about long-term omeprazole use for esophagus stricture after balloon procedure.

From the Research

Long-term Omeprazol Use for Esophagus Stricture after Balloon Procedure

• There is limited direct evidence on the long-term use of omeprazol for esophagus stricture after a balloon procedure 2, 3, 4, 5.
• However, studies have shown that proton pump inhibitors (PPIs), such as omeprazol, are effective in reducing gastric acid production and are commonly used in the treatment of acid-related disorders, including gastroesophageal reflux disease (GERD) and peptic ulcers 6.
• In the context of esophageal strictures, PPIs may be used to reduce acid production and prevent further irritation and inflammation of the esophagus, which can help to improve symptoms and prevent stricture recurrence 6.
• A study on the long-term effectiveness of balloon dilation for benign anastomotic strictures after esophagectomy found that balloon dilation was safe and effective, but recurrence was common, and factors such as early development of stricture and McKeown esophagectomy were associated with recurrent strictures 4.
• Another study on fluoroscopically guided balloon dilation of esophageal strictures in patients with dystrophic epidermolysis bullosa found that repeated balloon dilation was safe and effective, with marked clinical improvement in dysphagia and satisfactory long-term reintervention rates 5.
• While there is no direct evidence on the long-term use of omeprazol for esophagus stricture after a balloon procedure, the available evidence suggests that PPIs, such as omeprazol, may be beneficial in reducing acid production and preventing further irritation and inflammation of the esophagus, which can help to improve symptoms and prevent stricture recurrence 6.

Potential Benefits and Risks

• The potential benefits of long-term omeprazol use for esophagus stricture after a balloon procedure include reduced acid production, improved symptoms, and prevention of stricture recurrence 6.
• However, the potential risks and complications of long-term PPI use, such as increased risk of osteoporosis, vitamin B12 deficiency, and Clostridioides difficile infection, should also be considered 6.
• The decision to use omeprazol long-term for esophagus stricture after a balloon procedure should be made on a case-by-case basis, taking into account the individual patient's needs and medical history, and under the guidance of a healthcare professional 6.