Omeprazole treatment of reflux. Omeprazole in the treatment of gastroesophageal reflux disease and gastric and duodenal ulcers

For quotation: Vasiliev Yu.V. Omeprazole in the treatment of gastroesophageal reflux disease and peptic ulcer of the stomach and duodenum // RMJ. 2007. No. 4. P. 233

Acid-dependent diseases, which are primarily based on the occurrence and progression of the secretion of hydrochloric acid by the parietal cells of the gastric mucosa, represent a serious medical and social problem. Having a pronounced negative impact on the quality of life, acid-related diseases affect the interests of a significant part of the population, primarily those suffering from gastroesophageal reflux disease (GERD) and peptic ulcers of the stomach and duodenum, which are among the most common in the Russian Federation.

When treating patients suffering from acid-dependent diseases of the upper gastrointestinal tract, various drugs with different mechanisms of action are used. Along with the effectiveness of certain drugs in treating patients, the market cost of certain drugs is no less important when choosing treatment options. To a certain extent, this is mainly explained by the following: 1) insufficient standard of living of a significant part of the population; 2) the reluctance of some even well-to-do patients to spend money on purchasing relatively expensive drugs.
But is it always necessary to use quite expensive drugs in the treatment of patients? Experience shows that in a significant part of cases there is no need for many patients who suffer from various diseases to be treated with relatively expensive drugs. Doctors have a lot of inexpensive but effective drugs at their disposal that can be successfully used in the treatment of many acid-related diseases of the digestive system. One of such effective drugs available to the general population is omeprazole. Other advantages of this drug are the ability to influence one of the links in the work of the parietal cell - the electron-neutral proton pump and thus “control” the secretory process, eliminate heartburn (burning), pain behind the sternum, in the epigastric and pyloroduodenal areas.
Hydrochloric acid has been known for a long time, but only in recent years has the mechanism of its secretion by parietal cells of the gastric mucosa been established. Three types of receptors of parietal cells of the gastric mucosa are known (acetylcholine, histamine and gastrin), and the central role of H+,K+-ATPase in the process of hydrochloric acid secretion has been established. It has also been shown that microsomal ATPase catalyzes the oppositely directed transport of H+, K+ driven by ATP hydrolysis, and K+ limits this process. The proton pump is involved in the transfer of KCl from the parietal cell into the lumen of the stomach, and subsequently in the reverse transport of K+ in exchange for H+. This allows Cl- and H+ ions to enter the stomach. Through changes in the activity of H+,K+-ATPase, the influence of gastrin, histamine and acetylcholine on the production of hydrochloric acid is realized.
Most proton pump inhibitors, including omeprazole, consist of two types of optical isomers (R-isomer and S-isomer), identical in chemical structure, but differing in properties, due to which one of them may have a certain inhibitory effect, while the other may not. . Therefore, such proton pump inhibitors act for a longer period of time in some cases, and for a shorter period of time in other cases.
It is known that all proton pump inhibitors are absorbed in the small intestine, after which they are sent through the blood vessels to the stomach; their concentration is noted in the lumen of the secretory tubules of the parietal cell of the gastric mucosa. Conversion into the active form of proton pump inhibitors (sulfenamide) makes it possible to contact the thiol groups of cysteine, which makes it possible to inhibit this enzyme, resulting in a decrease in the secretion of hydrochloric acid.
Proton pump inhibitors, including omeprazole, are known to work best when taken by patients in the morning on an empty stomach (30-50 minutes before breakfast): for their full effect, it takes time for the capsules (tablets) to “pass” from the stomach into the duodenum before the patient will begin to eat food (with food intake, as is known, the secretion of hydrochloric acid increases), this is where proton pump inhibitors are needed to inhibit it. If there is no such coincidence (between the time of taking proton pump inhibitors and food intake), the proton pump inhibitors do not act at their full “power”.
The outer shell of some proton pump inhibitors, including omeprazole (especially towards the end of their shelf life), begins to collapse in the acidic environment of the stomach (especially during meals or in the afternoon, when the digestion process intensifies), which, of course, , increases the likelihood of their destruction and, accordingly, a decrease in their effectiveness. Therefore, when prescribing these medications to patients, it is necessary to take into account their shelf life.
The duration and severity of the antisecretory action of drugs that inhibit acid formation in the stomach are decisive factors for the effectiveness of antisecretory and anti-Helicobacter therapy that uses proton pump inhibitors. The results of assessing the antisecretory effect according to daily pH-metry data (before the start and on the 4th day of course treatment), with a pharmacological test of famotidine 40 mg, omeprazole 20 mg and rabeprazole 20 mg, taking into account such criteria of the antisecretory effect as the presence of refractoriness to the drug (no increase in pH to 4), duration of the latent period (time from the moment of taking the drug until the intragastric pH rises to more than 4), duration of action of the drug with an intragastric pH of more than 4, effectiveness of action (percentage of time with a pH of more than 4 during the day ). The following was established: refractoriness to the first dose of an antisecretory drug was detected in a significant number of patients, more often refractoriness was noted when patients took proton pump inhibitors, more pronounced to omeprazole (32%), less often to rabeprazole (15%). During a course of treatment, refractoriness to antisecretory drugs decreased to 21% for omeprazole, to 7.1% for famotidine, and to 5.4% for rabeprazole.
Studies conducted at TsNIIG using a test for reducing acid production, which allows determining the presence or absence of refractoriness to medications, showed that the test for reducing acid production makes it possible to assess the duration of action of drugs that inhibit the acid-producing function of the stomach. We noticed that when treating patients with famotidiomas (40 mg at night) in the morning, in 56% of cases in patients with peptic ulcers, pain in the epigastric region reappeared. According to a test to reduce acid production 12 hours after taking famotidine, the average pH value was equal to 1 unit; in the same patients, according to computer pH-metry, taking omeprazole 20 mg at night led to anacidity in the morning.
Omeprazole in the treatment of GERD
Studies we conducted earlier to study the effectiveness of omeprazole in the treatment of GERD in the stage of erosive (17 patients) reflux esophagitis and reflux esophagitis without erosion (15 patients) showed the following. After 4 weeks of treating patients with omeprazole 20 mg in the morning once a day, the main clinical symptoms of GERD disappeared in 16 (50%) of 32 patients; in 13 (41%) of them, according to esophagoscopy, inflammatory changes in the mucous membrane of the esophagus decreased, but erosions remained. Continuation of treatment of 19 patients for another 4 weeks with omeprazole 20 mg per day led to the disappearance of the main clinical symptoms of GERD in 11 of 19 patients, however, in 12 patients, according to esophagoscopy, signs of esophagitis remained, in 6 of them with the presence of erosions. 8-10 months after the end of treatment with omeprazole, only 17 out of 32 patients (53.9%) did not have the main clinical symptoms of GERD; in 18 out of 32 patients (56%), according to endoscopy, esophagitis was detected (in 9 of them with the presence of erosions) .
An analysis of the studies has shown that omeprazole at a dose of 20 mg per day often does not provide, especially at the beginning of treatment, rapid elimination of severe heartburn and pain in the sternum and/or epigastric region, mainly in patients with increased acid-forming function of the stomach. Therefore, subsequently, in the treatment of patients with GERD, we began to use omeprazole at least 40 mg per day, including in combination with histamine H2 receptor blockers (see below). This has made it possible to significantly increase the effectiveness of treatment of patients with GERD, especially in the endoscopically “negative” stage.
In order to increase the effectiveness of treatment for patients with GERD, in particular, to lengthen the duration of remission of the disease, as our observations have shown, after the disappearance of clinical symptoms of the disease and endoscopic signs of esophagitis, it is advisable to continue “maintenance” therapy of 20 mg once a day for 4-5 weeks.
The duration of drug treatment for patients with GERD during the period of exacerbation in some cases can be quite long - up to 10-12 months or more.
Further possible treatment options for patients: 1) if exacerbations of GERD occur - conducting a “course” of treatment; 2) if only episodic clinical symptoms appear, on-demand therapy (taking 20 mg of omeprazole to eliminate the main clinical symptoms); 3) constant treatment of patients with GERD with omeprazole in the required dosages (in cases where patients are forced to constantly take proton pump inhibitors, including using the treatment options for patients presented below); Among these patients, it is advisable to carry out differentiated selection for “open” or laparoscopic Nissen fundoplication.
Omeprazole in therapy
peptic ulcer
Our first observations showed the effectiveness of omeprazole in the treatment of uncomplicated gastric and duodenal ulcers (respectively, the size of the ulcers before treatment of patients was from 0.8 cm to 4 cm and from 0.4 cm to 1.5 cm), in the elimination of pain in the epigastric and /or in the pyloroduodenal area (during treatment from 7 to 10 days). During treatment with omeprazole 20 mg 2 times a day, the intensity of pain and the frequency of its occurrence began to gradually decrease (from the first day of taking the drug); healing of ulcers of the duodenal bulb within 2 weeks of treatment was established in 74% of cases, within 3 weeks - in 92.5% of cases, 4 weeks - in 100% of cases and stomach ulcers (in most patients) - within 2-5 weeks of treatment.
It is known that the results of treating patients with peptic ulcers with the same medications, including in the same dosages, can be ambiguous: they depend largely on the size of the ulcers and their location, on the duration of the peptic ulcer, complications, often the age of the patients and other factors. There may also be individual differences in the effects of certain drugs on specific patients with peptic ulcer disease. Considering the difficulties of selecting completely equal groups of patients, any comparison of the results of treatment of patients, especially those carried out on a pilot basis (Pilot Trials), is of relative importance. Nevertheless, our observations often showed greater effectiveness of omeprazole in reducing the healing time of ulcers of the duodenal bulb and stomach compared with cimetidine, ranitidine, famotidine and gastrocepin. Along with inhibition of acid formation in the stomach, omeprazole apparently also has some cytoprotective effects, which explains its greater effectiveness in healing gastric ulcers larger than 0.7-1 cm in size compared to histamine H2 receptor blockers and M1 blockers -muscarine receptors.
A study conducted earlier showed a fairly high clinical and pharmacoeconomic effectiveness of the use of omeprazole (20 mg per day) in the treatment of duodenal ulcer compared with ranitidine (300 mg per day). It was found that the time for regression of clinical manifestations of pain and dyspeptic syndromes in patients receiving ranitidine was 1.5-2 times longer than in patients receiving omeprazole; in the fourth week of treatment, healing of duodenal ulcers was achieved in 90% of cases among patients treated with omeprazole, and only in 75% of cases among patients treated with ranitidine. According to the same researchers, the average costs for monotherapy for recurrent peptic ulcer during a course of treatment with omeprazole were only slightly higher than material costs compared to a course of treatment with ranitidine.
A comparison of 24-hour pH-metry data to study the antisecretory activity of omeprazole and the results of treatment of patients with duodenal ulcer with omeprazole only 20 mg per day indicates that for the healing of ulcers it is not always necessary to suppress the secretion of hydrochloric acid throughout the day, which was confirmed by our observations . It is believed that optimal effectiveness in the treatment of peptic ulcer disease is possible by maintaining intragastric pH above 3-4 for 18 hours a day. However, in some patients (especially with increased acid-forming function of the stomach), it is still advisable to inhibit the secretion of hydrochloric acid throughout the day, which allows, as our observations have shown, to obtain greater efficiency in the treatment of patients, including accelerating the recovery of patients.
Peptic ulcer disease in most patients is associated with Helicobacter pylori (HP). When treating such patients, it is advisable to carry out anti-Helicobacter therapy. Some researchers believe that in order to eradicate HP, it is advisable to increase the pH to 5-7, which results in the formation of vegetative forms of microorganisms sensitive to antibiotics. One of the common points of view is that eradication therapy accelerates the healing of ulcers and reduces the frequency of recurrence of ulcers (accordingly, it increases the period of remission of the disease). However, it is known that even in cases of eradication of HP, prolongation of remission of peptic ulcer is not observed in all patients. Apparently, in the occurrence of relapses of peptic ulcer, along with HP, other factors also play a role in a significant proportion of patients. Relapses of peptic ulcer disease in some patients are possible even in the absence of HP contamination of the gastric mucosa.
A comparative study of the effectiveness of ranitidine bismuth citrate 400 mg 2 times a day and omeprazole 20 mg 2 times a day in the treatment of peptic ulcer disease showed that omeprazole relieves severe pain and heartburn faster; during treatment with ranitidine, healing of gastric ulcers in 3-4 weeks was noted in 54 of 59 patients (91.5%), duodenal ulcers - in 101 of 107 patients (94.4%); Over the same period, when treating patients with omeprazole, healing of gastric ulcers was noted in 97 of 113 patients (82.3%), duodenal ulcers - in 190 of 194 patients (97.9%). It should be noted that in the group of patients with gastric ulcer treated with omeprazole, there were more patients with gastric ulcers exceeding 1 cm in size compared to the group of patients with gastric ulcer treated with ranitidine bismuth citrate. There was no significant difference in the healing time of ulcers among patients with peptic ulcer disease with or without HP contamination of the gastric mucosa, due to which the patients additionally took 2 antibiotics in the first 10 days. HP eradication was achieved in 95.6% of cases.
New developments in the use of omeprazole in the treatment of GERD and peptic ulcers
It is known that the time of stay of patients in a hospital is limited by the periods determined by “insurance” medicine (15 days and 21-23 days, respectively). Therefore, it is necessary to accelerate the effectiveness of treatment of patients with GERD and peptic ulcer in the hospital. And in outpatient settings, it is necessary to strive for a faster improvement in the condition of patients and an increase in their quality of life. Previous studies have shown that the duration of action of antisecretory drugs (the most important criterion for their evaluation) after the first single dose of the drug was 9.1 hours for omeprazole and 7.8 hours for famotidine. Daily pH monitoring carried out in patients treated with omeprazole and famotidine indicates that their duration of action is 10.5 hours and 9.5 hours, respectively. The effectiveness of the antisecretory action of omeprazole, as our observations have shown, can be increased by increasing the daily dosage of the drug or combining it with histamine H2 receptor blockers.
In order to increase the effectiveness (reduce the time) of treatment of patients with GERD, peptic ulcer, as well as peptic ulcer combined with reflux esophagitis, we began to use omeprazole in combination with histamine H2 receptor blockers (ranitidine or famotidine), respectively, omeprazole 40 mg in the morning and ranitidine 150 mg or famotidine 20-40 mg in the evening, primarily in the treatment of patients with severe pain and heartburn, as well as with relatively large or complicated ulcers of the stomach and duodenum. The main goals of this combination of the above medications are to lengthen the period of inhibition of acid formation in the stomach, eliminate subjective symptoms of the disease and heal pathological changes in the mucous membrane of the esophagus, stomach and duodenum.
Why did we use omeprazole in combination with ranitidine or famotidine in the treatment of patients? Doubling the morning dosage of omeprazole to 40 mg and re-prescribing omeprazole in the evening at 20-40 mg most often led to the appearance of diarrhea, sometimes 2-3 days after starting the drug. Therefore, it is more advisable, as our observations have shown, to additionally prescribe histamine H2 receptor blockers in the evening in therapeutic doses (ranitidine or famotidine, 150 mg and 20-40 mg, respectively) for the following reasons: 1) with this combination of drugs it was possible to lengthen the period of daily inhibition of acid formation in the stomach; 2) this made it possible to quickly eliminate the subjective manifestations of the disease and accelerate the healing of pathological changes in the mucous membrane; 3) for the full effect of histamine H2 receptor blockers, the time they are taken by patients before, during or after meals is not significant, unlike proton pump inhibitors (in the afternoon, the digestion process usually intensifies; therefore, in the afternoon there is a greater the likelihood of destruction of the omeprazole capsule in the stomach); 4) it takes less time for histamine H2 receptor blockers taken orally to become effective than after taking proton pump inhibitors; 5) additional administration of histamine H2 receptor blockers, as a rule, did not lead to diarrhea and was well tolerated by patients; 6) this combination of the above drugs slightly reduced the cost of treating patients (compared to taking omeprazole 60-80 mg per day)
Analysis of the results of treatment of 33 patients with duodenal ulcer combined with reflux esophagitis, omeprazole 40 mg in the morning and famotidine 40 mg in the evening for 2-3 weeks (in the presence of HP contamination of the gastric mucosa in the first 10 days, patients additionally received amoxicillin and tetracycline, respectively 2000 mg and 1000 mg per day) allowed us to establish the following. During the treatment, pain and heartburn disappeared in the first 2-4 days, healing of ulcers of the duodenal bulb was noted in 11 of 17 patients (in 5 patients the ulcers decreased in size), “disappearance” of esophagitis during this period was noted in 7 of 33 patients.
When studying the results of treatment of 14 patients with gastric ulcer with omeprazole 40 mg in the morning and ranitidine 150 mg in the evening for 3 weeks (in addition, during the first 7 days, patients received amoxicillin 2000 mg per day and tetracycline 1000 mg per day), the following was established. Pain in the epigastric region disappeared within 3-7 days, dyspeptic disorders - within 3-10 days; after 21 days, 11 out of 14 patients had healing of the gastric ulcer (in 3 patients, the ulcers decreased in size). During a control examination of patients 28-42 days after the end of treatment, eradication of HP was established in all patients.
Conclusion
The results of the study indicate the possibility and feasibility of using omeprazole in the treatment of GERD and peptic ulcers of the stomach and duodenum, and allow us to consider this drug as one of the alternative drugs belonging to the class of proton pump inhibitors. The use of this drug is especially justified in the treatment of all patients with a relatively low level of income, as well as in the primary treatment of patients suffering from GERD and peptic ulcers of the stomach and duodenum, if necessary in combination with histamine H2 receptor blockers, including as basic drugs (when used in combination) in anti-Helicobacter (radiation) therapy for peptic ulcer disease.

Literature
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2. Kasyanenko V.I., Vasiliev Yu.V., Loginov A.S. Comparative data on the use of ranitidine bismuth citrate (piloride) and omeprazole in the treatment of peptic ulcers. // Russian. gastroenterol. zh-l.-1999.- No. 4.- P.118-119.
3. Loginov A.S., Vasiliev Yu.V., Kasyanenko V.I.// Efficacy of omeprazole in the treatment of peptic ulcer. Russian. J-l Gastroent., Hepatol., Coloproct.-1996.- Volume V1.-No. 3.- P.93-95.
4. Nikolskaya K.A. The first experience of the combined use of omeprazole, famot idine, metoclopramide (cerucal) in the treatment of duodenal ulcer combined with reflux esophagitis. // Experiment. and clinical gastroenterology.- 2003.- No. 1.- P. 100-101.
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6.Rakov A.L., Makarov Yu.S., Gorbakov V.V. et al. Comparative assessment of the antisecretory activity of famotidine, omeprazole and rabeprazole (pariet) in peptic ulcer disease, according to daily pH monitoring.//Military Medical Journal - 2001.-No.9.-P.54-58.
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11. Sjbstedt S., Sagar M., Lindberg G. et al. The duration and severity of the antisecretory action are decisive factors for the effectiveness of anti-Helicobacter treatment using a proton pump inhibitor in combination with amoxicillin. // Scand. J. Gastroenterol.-1998.-Vol.33.-P.39-43.

This information is intended for healthcare and pharmaceutical professionals. Patients should not use this information as medical advice or recommendations.

Omeprazole in the treatment of gastroesophageal reflux disease and gastric and duodenal ulcers

Yu.V. Vasiliev

But is it always necessary to use quite expensive drugs in the treatment of patients? Experience shows that in a significant part of cases there is no need for many patients who suffer from various diseases to be treated with relatively expensive drugs. Doctors have a lot of inexpensive but effective drugs at their disposal that can be successfully used in the treatment of many acid-related diseases of the digestive system. One of such effective drugs available to the general population is omeprazole. Other advantages of this drug are the ability to influence one of the links in the work of the parietal cell - the electron-neutral proton pump and thus “control” the secretory process, eliminate heartburn (burning), pain behind the sternum, in the epigastric and pyloroduodenal areas.

Hydrochloric acid has been known for a long time, but only in recent years has the mechanism of its secretion by parietal cells of the gastric mucosa been established. Three types of receptors of parietal cells of the gastric mucosa are known (acetylcholine, histamine and gastrin), and the central role of H+,K+-ATPase in the process of hydrochloric acid secretion has been established. It has also been shown that microsomal ATPase catalyzes the oppositely directed transport of H+, K+ driven by ATP hydrolysis, and K+ limits this process. The proton pump is involved in the transfer of KCl from the parietal cell into the lumen of the stomach, and subsequently in the reverse transport of K+ in exchange for H+. This allows Cl– and H+ ions to enter the stomach. Through changes in the activity of H+,K+–ATPase, the influence of gastrin, histamine and acetylcholine on the production of hydrochloric acid is realized.

Most proton pump inhibitors, including omeprazole, consist of two types of optical isomers (R-isomer and S-isomer), identical in chemical structure, but differing in properties, due to which one of them can have a certain inhibitory effect, while the other does not. . Therefore, such proton pump inhibitors act for a longer period of time in some cases, and for a shorter period of time in other cases.

It is known that all proton pump inhibitors are absorbed in the small intestine, after which they are sent through the blood vessels to the stomach; their concentration is noted in the lumen of the secretory tubules of the parietal cell of the gastric mucosa. Conversion into the active form of proton pump inhibitors (sulfenamide) makes it possible to contact the thiol groups of cysteine, which makes it possible to inhibit this enzyme, resulting in a decrease in the secretion of hydrochloric acid.

Proton pump inhibitors, including omeprazole, are known to work best when taken by patients in the morning on an empty stomach (30–50 minutes before breakfast): for their full effect, it takes time for the capsules (tablets) to “pass” from the stomach into the duodenum before the patient will begin to eat (with food intake, as is known, the secretion of hydrochloric acid increases), this is where proton pump inhibitors are needed to inhibit it. If there is no such coincidence (between the time of taking proton pump inhibitors and food intake), the proton pump inhibitors do not act at their full “power”.

The outer shell of some proton pump inhibitors, including omeprazole (especially towards the end of their shelf life), begins to collapse in the acidic environment of the stomach (especially during meals or in the afternoon, when the digestion process intensifies), which, of course, , increases the likelihood of their destruction and, accordingly, a decrease in their effectiveness. Therefore, when prescribing these medications to patients, it is necessary to take into account their shelf life.

The duration and severity of the antisecretory action of drugs that inhibit acid formation in the stomach are decisive factors for the effectiveness of antisecretory and anti-Helicobacter therapy that uses proton pump inhibitors. The results of assessing the antisecretory effect according to daily pH-metry data (before the start and on the 4th day of course treatment), with a pharmacological test of famotidine 40 mg, omeprazole 20 mg and rabeprazole 20 mg, taking into account such criteria of the antisecretory effect as the presence of refractoriness to the drug (no increase in pH to 4), duration of the latent period (time from the moment of taking the drug until the intragastric pH rises to more than 4), duration of action of the drug with an intragastric pH of more than 4, effectiveness of action (percentage of time with a pH of more than 4 during the day ). The following was established: refractoriness to the first dose of an antisecretory drug was detected in a significant number of patients, more often refractoriness was noted when patients took proton pump inhibitors, more pronounced to omeprazole (32%), less often to rabeprazole (15%). During a course of treatment, refractoriness to antisecretory drugs decreased to 21% for omeprazole, to 7.1% for famotidine, and to 5.4% for rabeprazole.

Studies conducted at TsNIIG using a test for reducing acid production, which allows determining the presence or absence of refractoriness to medications, showed that the test for reducing acid production makes it possible to assess the duration of action of drugs that inhibit the acid-producing function of the stomach. We noticed that when treating patients with famotidiomas (40 mg at night) in the morning, in 56% of cases in patients with peptic ulcers, pain in the epigastric region reappeared. According to a test to reduce acid production 12 hours after taking famotidine, the average pH value was equal to 1 unit; in the same patients, according to computer pH-metry, taking omeprazole 20 mg at night led to anacidity in the morning.

Omeprazole in the treatment of GERD

Studies we conducted earlier to study the effectiveness of omeprazole in the treatment of GERD in the stage of erosive (17 patients) reflux esophagitis and reflux esophagitis without erosion (15 patients) showed the following. After 4 weeks of treating patients with omeprazole 20 mg in the morning once a day, the main clinical symptoms of GERD disappeared in 16 (50%) of 32 patients; In 13 (41%) of them, according to esophagoscopy, inflammatory changes in the mucous membrane of the esophagus decreased, but erosion remained. Continuation of treatment of 19 patients for another 4 weeks with omeprazole 20 mg per day led to the disappearance of the main clinical symptoms of GERD in 11 of 19 patients, however, in 12 patients, according to esophagoscopy, signs of esophagitis remained, in 6 of them with the presence of erosions. 8–10 months after the end of treatment with omeprazole, only 17 out of 32 patients (53.9%) had no main clinical symptoms of GERD; in 18 out of 32 patients (56%), according to endoscopy, esophagitis was detected (in 9 of them with the presence of erosions) .

An analysis of the studies has shown that omeprazole at a dose of 20 mg per day often does not provide, especially at the beginning of treatment, rapid elimination of severe heartburn and pain in the sternum and/or epigastric region, mainly in patients with increased acid-forming function of the stomach. Therefore, subsequently, in the treatment of patients with GERD, we began to use omeprazole at least 40 mg per day, including in combination with histamine H2 receptor blockers (see below). This has significantly increased the effectiveness of treatment for patients with GERD, especially in the endoscopically “negative” stage.

In order to increase the effectiveness of treatment for patients with GERD, in particular, to lengthen the duration of remission of the disease, as our observations have shown, after the disappearance of clinical symptoms of the disease and endoscopic signs of esophagitis, it is advisable to continue “maintenance” therapy of 20 mg once a day for 4–5 weeks.

The duration of drug treatment for patients with GERD during the period of exacerbation in some cases can be quite long - up to 10–12 months or more.

Further possible treatment options for patients: 1) if exacerbations of GERD occur - conducting a “course” of treatment; 2) if only episodic clinical symptoms appear, on-demand therapy (taking 20 mg of omeprazole to eliminate the main clinical symptoms); 3) constant treatment of patients with GERD with omeprazole in the required dosages (in cases where patients are forced to constantly take proton pump inhibitors, including using the treatment options for patients presented below); Among these patients, it is advisable to carry out differentiated selection for “open” or laparoscopic Nissen fundoplication.

Omeprazole in the treatment of peptic ulcer

Our first observations showed the effectiveness of omeprazole in the treatment of uncomplicated gastric and duodenal ulcers (respectively, the size of the ulcers before treatment of patients was from 0.8 cm to 4 cm and from 0.4 cm to 1.5 cm), in the elimination of pain in the epigastric and /or in the pyloroduodenal area (during treatment from 7 to 10 days). During treatment with omeprazole 20 mg 2 times a day, the intensity of pain and the frequency of its occurrence began to gradually decrease (from the first day of taking the drug); healing of ulcers of the duodenal bulb within 2 weeks of treatment was established in 74% of cases, within 3 weeks – in 92.5% of cases, 4 weeks – in 100% of cases and stomach ulcers (in most patients) – within 2–5 weeks of treatment.

It is known that the results of treating patients with peptic ulcers with the same medications, including in the same dosages, can be ambiguous: they depend largely on the size of the ulcers and their location, on the duration of the peptic ulcer, complications, often the age of the patients and other factors. There may also be individual differences in the effects of certain drugs on specific patients with peptic ulcer disease. Considering the difficulties of selecting completely equal groups of patients, any comparison of the results of treatment of patients, especially those carried out on a pilot basis (Pilot Trials), is of relative importance. Nevertheless, our observations often showed greater effectiveness of omeprazole in reducing the healing time of ulcers of the duodenal bulb and stomach compared with cimetidine, ranitidine, famotidine and gastrocepin. Along with inhibition of acid formation in the stomach, omeprazole apparently also has some cytoprotective effects, which explains its greater effectiveness in healing gastric ulcers larger than 0.7–1 cm in size compared to histamine H2 receptor blockers and M1 blockers -muscarine receptors.

A study conducted earlier showed a fairly high clinical and pharmacoeconomic effectiveness of the use of omeprazole (20 mg per day) in the treatment of duodenal ulcer compared with ranitidine (300 mg per day). It was found that the time for regression of clinical manifestations of pain and dyspeptic syndromes in patients receiving ranitidine was 1.5–2 times longer than in patients receiving omeprazole; in the fourth week of treatment, healing of duodenal ulcers was achieved in 90% of cases among patients treated with omeprazole, and only in 75% of cases among patients treated with ranitidine. According to the same researchers, the average costs for monotherapy for recurrent peptic ulcer during a course of treatment with omeprazole were only slightly higher than material costs compared to a course of treatment with ranitidine.

A comparison of daily pH-metry data to study the antisecretory activity of omeprazole and the results of treatment of patients with duodenal ulcer with omeprazole only 20 mg per day indicates that for the healing of ulcers it is not always necessary to suppress the secretion of hydrochloric acid throughout the day, which was confirmed by our observations . It is believed that optimal effectiveness in the treatment of peptic ulcer disease is possible by maintaining intragastric pH above 3–4 for 18 hours a day. However, in some patients (especially with increased acid-forming function of the stomach), it is still advisable to inhibit the secretion of hydrochloric acid throughout the day, which allows, as our observations have shown, to obtain greater efficiency in the treatment of patients, including accelerating the recovery of patients.

Peptic ulcer disease in most patients is associated with Helicobacter pylori (HP). When treating such patients, it is advisable to carry out anti-Helicobacter therapy. Some researchers believe that in order to eradicate HP, it is advisable to increase the pH to 5–7, which results in the formation of vegetative forms of microorganisms sensitive to antibiotics. One of the common points of view is that eradication therapy accelerates the healing of ulcers and reduces the frequency of recurrence of ulcers (accordingly, it increases the period of remission of the disease). However, it is known that even in cases of eradication of HP, prolongation of remission of peptic ulcer is not observed in all patients. Apparently, in the occurrence of relapses of peptic ulcer, along with HP, other factors also play a role in a significant proportion of patients. Relapses of peptic ulcer disease in some patients are possible even in the absence of HP contamination of the gastric mucosa.

A comparative study of the effectiveness of ranitidine bismuth citrate 400 mg 2 times a day and omeprazole 20 mg 2 times a day in the treatment of peptic ulcer disease showed that omeprazole relieves severe pain and heartburn faster; during treatment with ranitidine, healing of gastric ulcers in 3–4 weeks was observed in 54 of 59 patients (91.5%), duodenal ulcers - in 101 of 107 patients (94.4%); Over the same period, when treating patients with omeprazole, healing of gastric ulcers was noted in 97 of 113 patients (82.3%), duodenal ulcers - in 190 of 194 patients (97.9%). It should be noted that in the group of patients with gastric ulcer treated with omeprazole, there were more patients with gastric ulcers exceeding 1 cm in size compared to the group of patients with gastric ulcer treated with ranitidine bismuth citrate. There was no significant difference in the healing time of ulcers among patients with peptic ulcer disease with or without HP contamination of the gastric mucosa, due to which the patients additionally took 2 antibiotics in the first 10 days. HP eradication was achieved in 95.6% of cases.

New developments in the use of omeprazole in the treatment of GERD and peptic ulcers

It is known that the time of stay of patients in hospital is limited by the periods determined by “insurance” medicine (15 days and 21–23 days, respectively). Therefore, it is necessary to accelerate the effectiveness of treatment of patients with GERD and peptic ulcer in the hospital. And even in outpatient settings, it is necessary to strive for a faster improvement in the condition of patients and an increase in their quality of life. Previous studies have shown that the duration of action of antisecretory drugs (the most important criterion for their evaluation) after the first single dose of the drug was 9.1 hours for omeprazole and 7.8 hours for famotidine. Daily pH monitoring carried out in patients treated with omeprazole and famotidine indicates that their duration of action is 10.5 hours and 9.5 hours, respectively. The effectiveness of the antisecretory action of omeprazole, as our observations have shown, can be increased by increasing the daily dosage of the drug or combining it with histamine H2 receptor blockers.

In order to increase the effectiveness (reduce the time) of treatment of patients with GERD, peptic ulcer, as well as peptic ulcer combined with reflux esophagitis, we began to use omeprazole in combination with histamine H2 receptor blockers (ranitidine or famotidine), respectively, omeprazole 40 mg in the morning and ranitidine 150 mg or famotidine 20–40 mg in the evening, primarily in the treatment of patients with severe pain and heartburn, as well as with relatively large or complicated ulcers of the stomach and duodenum. The main goals of this combination of the above medications are to lengthen the period of inhibition of acid formation in the stomach, eliminate subjective symptoms of the disease and heal pathological changes in the mucous membrane of the esophagus, stomach and duodenum.

Why did we use omeprazole in combination with ranitidine or famotidine in the treatment of patients? Doubling the morning dosage of omeprazole to 40 mg and re-prescribing omeprazole in the evening at 20–40 mg most often led to the appearance of diarrhea, sometimes 2–3 days after starting the drug. Therefore, it is more advisable, as our observations have shown, to additionally prescribe histamine H2 receptor blockers in the evening in therapeutic doses (ranitidine or famotidine, 150 mg and 20–40 mg, respectively) for the following reasons: 1) with this combination of drugs it was possible to lengthen the period of daily inhibition of acid formation in the stomach; 2) this made it possible to quickly eliminate the subjective manifestations of the disease and accelerate the healing of pathological changes in the mucous membrane; 3) for the full effect of histamine H2 receptor blockers, the time they are taken by patients before, during or after meals is not significant, unlike proton pump inhibitors (in the afternoon the digestion process usually intensifies; therefore, in the afternoon there is a greater the likelihood of destruction of the omeprazole capsule in the stomach); 4) it takes less time for histamine H2 receptor blockers taken orally to become effective than after taking proton pump inhibitors; 5) additional administration of histamine H2 receptor blockers, as a rule, did not lead to diarrhea and was well tolerated by patients; 6) this combination of the above drugs slightly reduced the cost of treating patients (compared to taking omeprazole 60–80 mg per day)

Analysis of the results of treatment of 33 patients with duodenal ulcer combined with reflux esophagitis, omeprazole 40 mg in the morning and famotidine 40 mg in the evening for 2–3 weeks (in the presence of HP contamination of the gastric mucosa in the first 10 days, patients additionally received amoxicillin and tetracycline, respectively 2000 mg and 1000 mg per day) allowed us to establish the following. During the treatment, pain and heartburn disappeared in the first 2–4 days, healing of ulcers of the duodenal bulb was noted in 11 of 17 patients (in 5 patients the ulcers decreased in size), “disappearance” of esophagitis during this period was noted in 7 of 33 patients.

When studying the results of treatment of 14 patients with gastric ulcer with omeprazole 40 mg in the morning and ranitidine 150 mg in the evening for 3 weeks (in addition, during the first 7 days, patients received amoxicillin 2000 mg per day and tetracycline 1000 mg per day), the following was established. Pain in the epigastric region disappeared within 3–7 days, dyspeptic disorders – within 3–10 days; after 21 days, 11 out of 14 patients had healing of the gastric ulcer (in 3 patients, the ulcers decreased in size). During a control examination of patients 28–42 days after the end of treatment, eradication of HP was established in all patients.

Conclusion

The results of the study indicate the possibility and feasibility of using omeprazole in the treatment of GERD and peptic ulcers of the stomach and duodenum, and allow us to consider this drug as one of the alternative drugs belonging to the class of proton pump inhibitors. The use of this drug is especially justified in the treatment of all patients with a relatively low level of income, as well as in the primary treatment of patients suffering from GERD and peptic ulcers of the stomach and duodenum, if necessary in combination with histamine H2 receptor blockers, including as basic drugs (when used in combination) in anti-Helicobacter (radiation) therapy for peptic ulcer disease.

Literature

1. Vasiliev Yu.V. Diseases of the digestive system. Histamine H2 receptor blockers. // M., 2002, “Double Freig”, P. 93.

2. Kasyanenko V.I., Vasiliev Yu.V., Loginov A.S. Comparative data on the use of ranitidine bismuth citrate (piloride) and omeprazole in the treatment of peptic ulcers. // Russian. gastroenterol. f–l. –1999. – No. 4. – P.118–119.

3. Loginov A.S., Vasiliev Yu.V., Kasyanenko V.I. // The effectiveness of omeprazole in the treatment of peptic ulcer. Russian. g–l Gastroent., Hepatol., Coloproct. –1996. – Volume V1. – No. 3. – P.93–95.

4. Nikolskaya K.A. The first experience of the combined use of omeprazole, famot idine, metoclopramide (cerucal) in the treatment of duodenal ulcer combined with reflux esophagitis. // Experiment. and clinical gastroenterology. – 2003. – No. 1. – P.100–101.

5. Orlova E.A. Dynamic study of the acid-forming function of the stomach as a method of correcting the treatment of patients with peptic ulcer. // Russian. med.g–l. – 1998. – No. 2. – P.68.

6.Rakov A.L., Makarov Yu.S., Gorbakov V.V. et al. Comparative assessment of the antisecretory activity of famotidine, omeprazole and rabeprazole (Pariet) in peptic ulcer disease, according to 24-hour pH monitoring. // Military medical railway. – 2001. – No. 9. – P.54–58.

7. Rud M.V. Combined use of proton pump inhibitors and histamine H2 receptor blockers in the treatment of gastric ulcer. // Experiment. and clinical gastroenterology. – 2003. – No. 1. – P. 105.

8. Tkachenko E.I. Optimal therapy for peptic ulcer disease. // Wedge. honey. – 1999. – No. 8. – P.35–40.

9.Uspensky Yu.P., Sablin O.A. Clinical and pharmacoeconomic aspects of the use of the drug "Omez" in the treatment of peptic ulcer disease. // Gastrobulletin. – 2001. – No. 1. – P.22–23.

10. Burger D.W., Chiverton K.D., Hunt R.H. Is There an optimal degree of acid suppression for healing of duodenal ulcers? A model of the relationship between ulcer healing and acid suppression. // Gastroenterology. – 1990. – Vol. 99. – P.345–351.

11. Sjbstedt S., Sagar M., Lindberg G. et al. The duration and severity of the antisecretory action are decisive factors for the effectiveness of anti-Helicobacter treatment using a proton pump inhibitor in combination with amoxicillin. // Scand. J. Gastroenterol. – 1998. – Vol.33. P.39–43.

Esophagitis is a chronic disease in which an inflammatory process occurs in the mucous membrane of the esophagus.

It begins in its most superficial layers and gradually penetrates into the deeper ones, leading to the development of quite serious complications.

This is the most common disease of the esophagus and one of the most common diseases of the digestive system.

In most cases, esophagitis affects men. It can begin at a fairly young age - 25-30 years. In every third person, the disease proceeds for a long time without any symptoms, but more often it makes itself felt quite clearly.

What are esophagitis?

Doctors distinguish several approaches to the classification of esophagitis. It can occur suddenly and pass quickly, or it can last for years, with periods of exacerbation and remission gradually replacing each other. The disease is also divided according to the nature of the inflammatory process.

There are catarrhal, edematous, erosive, pseudomembranous, hemorrhagic, necrotic and other forms.

Esophagitis is also divided for a reason: for some it is the consumption of unhealthy food, for others it is smoking and alcohol abuse (with frequent episodes of vomiting), for others it is poisoning with toxic products.

The most common form of esophagitis is gastroesophageal reflux disease. It occurs due to incompetence of the sphincter between the esophagus and the stomach in combination with an increased level of acidity of gastric juice.

The esophagus has a more neutral environment, so when hydrochloric acid from the stomach is thrown there, it has a detrimental effect on the mucous membrane.

Over time, erosion appears. Refluxes do not always occur, but when intra-abdominal pressure increases or a person makes mistakes in nutrition. In the first case, this is lifting weights, bending over, pregnancy, in the second - spicy, fatty, smoked and fried foods.

How to suspect esophagitis

Esophagitis may remain unrecognized for a long time. However, as the disease progresses, a person notices the appearance of heartburn - the leading symptom of this disease.

It occurs as a result of the irritating effect of hydrochloric acid on the mucous membrane of the esophagus, or when food passes through it.

Patients describe a specific burning sensation that appears either directly behind the sternum or deep in the chest. It arises in the epigastric region and rises upward.

Sometimes heartburn is accompanied by characteristic sound effects, which are often heard by others.

Patients are very embarrassed by this fact and try to avoid situations where heartburn could hypothetically occur. Signs of esophagitis also include a sour taste in the mouth, increased salivation (hypersalivation), a feeling of pressure and chest pain.

In acute esophagitis caused by burns from chemicals or burning food, the clinical picture is more vivid.

First of all, the patient is bothered by chest pain, sometimes it becomes so severe that a painful shock develops. The swallowing process is disrupted, sometimes to the point of complete inability to swallow both solid and liquid food. In the most severe cases, bleeding may develop.

How to treat esophagitis

When the first signs of esophagitis appear, it is important to consult a doctor in time. The leading diagnostic method is endoscopic examination of the esophagus.

Visually, the doctor can assess the condition of the mucous membrane, the nature of the inflammatory process, the presence of erosions or ulcers. Once a diagnosis is made, it is important to begin treatment promptly.

Antacids are considered the easiest way to relieve heartburn. Among them are such well-known ones as Almagel, Maalox, Rennie, etc.

They allow you to reduce the level of acidity, have a restorative effect on the esophageal mucosa, as a result of which they quickly lead to a reduction in discomfort.

These drugs, however, do not affect the course of the disease: after the period of their action, all unpleasant sensations return. This is due to the fact that the drugs do not eliminate sphincter incompetence and do not affect the production of hydrochloric acid by the stomach.

Some patients still use popular folk remedies such as baking soda and milk for heartburn. They do not stand up to criticism because they lead to the production of even more hydrochloric acid after a few minutes.

with esophagitis

One of those drugs that really influence the course of the disease and lead to a gradual regression of unpleasant symptoms, that is, they actually treat this disease, is Omeprazole.

It reduces the production of hydrochloric acid by the lining cells of the stomach, that is, it reduces the level of acidity in this organ. As a result of this, reflux occurs less frequently, and even if they do occur, the contents of the stomach do not irritate the esophageal mucosa as much.

The drug is available in the form of tablets and solution for intravenous administration. Droppers are used in acute illness, serious condition, or when the patient is physically unable to swallow pills.

When the patient’s condition is stabilized, the patient is transferred to oral medication, as it is safer, cheaper and does not take as long.

The treatment course is 2 tablets of 10, 20 or 40 mg per day, after which a prophylactic single dose of Omeprazole begins for a long time.

As a rule, treatment with this drug is quite mild. Undesirable side effects do not develop often.

In rare cases, allergic reactions, anemia, headache and dizziness, sleep disturbance or drowsiness, blurred vision, nausea, dyspeptic disorders, increased liver transaminases, etc. are possible.

If they are detected, the doctor transfers the patient to another drug of the same group (proton pump inhibitors) or other acid-lowering drugs.

Despite the fact that Omeprazole is sold in pharmacies without a prescription, that is, theoretically does not require a medical examination, in reality this should not be the case.

Before use, it is still worth consulting with a specialist, since only a doctor will be able to make an accurate diagnosis and identify possible complications in a timely manner.

Pharmacy chains offer many medications that are used in the treatment of reflux esophagitis, one of these is the drug Omeprazole, which regulates the flow of hydrochloric acid and has a bactericidal effect on the gastrointestinal tract.

Omeprazole is a popular remedy for smoothing the symptoms of burning.

Release form and composition

A drug prescribed for gastrointestinal diseases, Omeprazole is available in tablets, capsules and powder for intravenous administration. Gelatin capsules are produced in packs of seven pieces in a blister pack; there can be from one to four plates in a pack. You can find capsules in polymer jars that hold 30-40 pieces. The powder for preparing the solution is available in a 40 mg bottle and five bottles per package. You can purchase the drug in pharmacies only with a doctor's prescription. Omeprazole contains the following auxiliary components:

glycerol;
charming red dye AC;
gelatin;
methylparaben;
food additive E 171;
propylparaben;
sodium lauryl sulfate;
purified water.

The active ingredient is omeprazole.

pharmachologic effect

When the medicine "Omeprazole" penetrates the acidic environment of the stomach and deep into the cells that are responsible for the production of digestive juice and enzyme, it begins to regulate these processes. The drug reduces the production of gastric juice and its level of activity, and has a detrimental effect on Helicobacter bacteria, which are observed in reflux esophagitis.

"Omeprazole" capsules contain film-coated microgranules, which, after dissolution, begin to act 60 minutes after taking the medicine and can last up to two hours. The duration of action reaches 24 hours.

Indications for use

The drug is used when it is necessary to treat the upper gastrointestinal tract, namely for the following diseases:

A broad-spectrum drug for the treatment of a number of gastrointestinal diseases.

gastric ulcer caused by Helicobatheri infection;
Zolliger-Ellison syndrome;
duodenal ulcer;
gastroesophageal reflux;
severe heartburn, the duration of which reaches two days;
gastritis resulting from the use of non-steroidal drugs that relieve inflammation;
erosive esophagitis;
hypersecretory disorders of the digestive system;
polyendocrine adenomatosis;
recurrence of a chronic duodenal ulcer;
relapse of stress and drug ulcers.

How does Omeprazole help with esophagitis?

To treat reflux esophagitis, the drug Omeprazole is used, which has the following effect: normalizes the level of acidity in the stomach. In addition, it regulates the functioning of cells responsible for the secretion of hydrochloric acid and has a protective function on the cells and organs of the digestive system. Due to these properties, Omeprazole not only relieves an attack of heartburn, but also acts as an excellent prophylactic for exacerbations of gastrointestinal tract diseases.

Directions for use and dosage

To achieve an effective result in the treatment of reflux esophagitis with the drug Omeprazole, you should follow the attached instructions. Manufacturers of the drug indicate that it is enough to take it once a day, preferably in the morning and regardless of meals.

Often, Omeprazole is taken at 0.2 g per day.

The drug, available in capsules, should be swallowed whole, without chewing, and washed down with several sips of water. When treating esophagitis, the doctor prescribes 20 mg of medication once every 24 hours. In case of severe illness, it is allowed to increase the dosage to forty milligrams. The duration of treatment can last from four to eight weeks. If the doctor prescribes Omeprazole in combination, then therapy for esophagitis with this medicine lasts 60 days.

Results and effectiveness of treatment

When using the prescribed dosage, namely one capsule per day, the results of the drug are observed quickly. A decrease in pronounced symptoms occurs after an hour. The effectiveness of the drug is observed within four weeks or, in extreme cases, after two months, which is typical for patients with severe disease.

During pregnancy and lactation

The drug "Omeprazole", which is intended for the treatment of esophagitis, is not recommended for use by pregnant women and during breastfeeding.

Use in childhood

Children under five years of age are not allowed to take the drug Omeprazole. However, at the discretion of the doctor, the drug can be prescribed to young children with acute ailments of the upper digestive tract. Treatment in children with this medication should be carried out exclusively under the guidance of a physician. Children's dosage is calculated taking into account the baby's body weight. If the weight is up to ten kilograms, then the medicine is prescribed five milligrams once a day. If body weight is 10−20 kg, then the dosage is doubled and is 10 mg. A child weighing more than 20 kg is prescribed the drug in a volume of 20 mg for 24 hours.

Contraindications

Like all medications, Omeprazole has contraindications. Therefore, this medicine is not prescribed in the following cases:

Restrictions on treatment apply to children, breastfeeding children and for diseases of other organs.

if the patient is under five years of age;
if there is hypersensitivity to the components of the drug;
if a woman is breastfeeding;
with liver and kidney failure.

For pregnant women, the medicine is prescribed with caution and under the supervision of a doctor.

Side effects

In some cases, when treating esophagitis with Omeprazole, the following side effects may be observed:

diarrhea;
gagging;
constipation;
nausea;
hives;
painful gas formation;
painful sensations in the abdomen;
muscle and joint pain;
taste bud disorders;
depression;
feeling of dryness in the mouth;
failure of the liver;

excessive sweating;
dizziness;
blurred vision;
myalgia;
fever;
hepatitis;
stomatitis;
arthralgia;
headache;
thrombocytopenia;
itching of the skin;
peripheral edema;
leukopenia;
skin rash;
alopecia;
anaphylactic shock;
general malaise;
gynecomastia.

Overdose

If you do not adhere to the doctor's recommendations and do not follow the instructions for the drug, an overdose may occur, which is manifested by arrhythmia, drowsiness, nausea, tachycardia and headache. The patient may notice dry mouth and blurred vision.

Interaction with other drugs

In the process of treating gastrointestinal diseases with Omeprazole and other drugs, one should take into account its ability to reduce the absorption of iron salts, ketoconazole and ampicillin esters, and increase the concentration of clarithromycin in the blood plasma. When used in parallel with other medications, it can enhance the effect of the inhibitor in the circulatory system and in other medications.

special instructions

Before starting treatment of esophagitis with the drug Omeprazole, it is necessary to exclude malignant tumors in the patient, since during therapy it is possible to hide the signs of cancer, which will delay the correct diagnosis and the main antitumor treatment. In addition, the patient should not have infections in the gastrointestinal tract such as salmonella, compylobacter and others, since the medicine can only exaggerate their reproduction. The doctor must rule out liver and kidney failure.

"Omeprazole" or "Omez"?

Many patients compare two medications with similar names, Omeprazole and Omez, and want to find out which one is better and more effective. Thus, “Omeprazole” is a cheap analogue of “Omez” with the active substance omeprazole. Omeprazole uses cheaper substances, which causes its slow speed in achieving maximum concentration in the blood.

"Omez", like "Omeprazole", quickly enters the mucous layer of the stomach and is absorbed from the gastrointestinal tract into the blood. "Omez" reaches its maximum effect within 60 minutes after consuming the capsules.

"Omeprazole" has an analogue with a similar name - "Omez".

A distinctive feature of Omez from its analogue drug is the country of origin. "Omeprazole" is produced in Russia, when "Omez" comes from India, this has a greater impact on the price of drugs. "Omez" was released earlier than its analogue, so it is an original medicine. The doctor prescribes "Omez" or its generic, based on the severity of the disease, since the original drug uses more effective substances, then "Omez" has more advantages over "Omeprazole".

Analogs

Pharmacy chains offer a large selection of analogues of the drug Omeprazole, which have the same active ingredient, but differ significantly in price. Generic drugs include the following:

"Ocide";
"Gastrozol";
"Omezol";
"Bioprazole";
"Pepticum";
"Tserol";
"Ultop";
"Omefez";
"Losek";
"Upzol";
"Hasek";
"Omeprazole-Richter".

You should not self-medicate and neglect the recommended dosages, as this can lead to serious consequences in the form of side effects. Medicines for esophagitis are prescribed exclusively by the attending physician.

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Omeprazole - use as prescribed by a doctor

Diseases of the digestive system often develop against the background of high acidity of gastric juice. In such cases, omeprazole is often included in the complex treatment of patients. The use of omeprazole can significantly alleviate the condition of patients who are always bothered by abdominal pain, heartburn and sour belching.

The use of omeprazole for gastric and duodenal ulcers

Peptic ulcer of the stomach and duodenum almost always develops against the background of increased secretory function of the stomach. Too acidic an environment corrodes the mucous membrane of the stomach and duodenum. An acidic environment is also favorable for the life of the causative agent of peptic ulcer Helicobacter pylori. During their life, these bacteria release ammonium, which is neutralized by an acidic environment. When acidity decreases, ammonium is not neutralized and has a toxic effect on the bacteria themselves.

For peptic ulcers, omeprazole reduces acidity by affecting the secretion of hydrochloric acid at the cellular level. As a result, the gastric mucosa is not irritated, but uncomfortable conditions are created for the infectious agent.

For antibiotics (they are used to destroy Helicobacter pylori), a slightly acidic and alkaline environment is, on the contrary, comfortable. Therefore, today, omeprazole is almost always included in the complex treatment of peptic ulcer disease, especially if Helicobacter pylori was identified during the examination.

Take omeprazole once a day before meals, in the morning. For gastric ulcers, 20 or 40 mg per dose for a month. If there is an improvement, but the ulcer has not healed completely, then the course of treatment is repeated. For duodenal ulcer, the same dose of omeprazole is taken for two weeks and, if necessary, the course is repeated.

If the goal of treatment is to remove Helicobacter pylori from the body, then omeprazole is prescribed 20 mg twice a day for two weeks along with antibacterial drugs.

The use of omeprazole for reflux esophagitis

Between the esophagus and the stomach there is a circular muscle - the sphincter, which blocks the possibility of acidic stomach contents entering the esophagus. But in some cases, the sphincter does not work and the contents of the stomach enter the esophagus, irritating its walls. If the acidity of the gastric juice is increased, the inflammatory process in the esophagus develops quickly and is severe. This disease is called reflux esophagitis.

The walls of the esophagus with reflux esophagitis first become inflamed, then the inflammatory process can become purulent with the formation of multiple small abscesses and phlegmons. The pustules open and the surface of the walls of the esophagus becomes covered with ulcers. There may even be a perforation of the wall of the esophagus, as well as bleeding from the blood vessels supplying the esophagus.

Patients with reflux esophagitis experience terrible suffering. They are worried about constant heartburn, which turns into burning and pain behind the sternum, and sour belching. In the later stages of the disease, blood clots and pus are regurgitated along with food masses.

Omeprazole can alleviate the condition of patients with reflux esophagitis: lowering the acidity of gastric juice will reduce heartburn and irritation of the stomach walls, which will ultimately contribute to remission of the disease.

Omeprazole is prescribed in courses of 20 mg once a day for a month. If necessary, the course of treatment can be repeated.

For what other diseases is omeprazole prescribed?

Ulcerative processes in the walls of the stomach can be a consequence of stress or taking various medications. Thus, stomach ulcers very often develop in patients with rheumatoid arthritis who constantly take non-steroidal anti-inflammatory drugs (NSAIDs - aspirin, diclofenac, indomethacin, etc.) to relieve joint pain.

In order to reduce irritation of the stomach wall, such patients are prescribed courses of omeprazole. When treating an ulcerative process, it is prescribed 20 mg once a day for a month, if necessary, the course of treatment is repeated. To prevent peptic ulcers, omeprazole is prescribed along with NSAIDs throughout the course of treatment.

Another indication for taking omeprazole is diseases of other organs and systems, accompanied by increased secretion. For example, Zollinger-Ellison syndrome is a benign tumor of the pancreas that produces gastrin, which stimulates the secretion of gastric juice. The disease can be severe; omeprazole is prescribed in individually selected dosages; the duration of treatment courses is also individual.

Galina Romanenko

Article tags:

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The use of omeprazole 10 mg in the prevention of relapse of reflux esophagitis

The study is aimed at determining the optimal maintenance dose of omeprazole in the treatment of reflux esophagitis.

193 patients who were asymptomatic and in remission after 4 or 8 weeks of omeprazole treatment were randomized, double-blind, to receive omeprazole 10 mg once daily (n = 60 evaluable) or omeprazole 20 mg once daily per day (n = 68), or placebo (n = 62) for one year or relapse with symptoms. Omeprazole treatment at both doses was more effective than placebo in preventing symptomatic relapse (p

Omeprazole 20 mg once daily is an effective drug used in the long-term treatment of reflux esophagitis.1,2 Rational treatment should be accompanied by minimal drug exposure while providing maximum effectiveness for most patients3. Therefore, prerequisites arose for studying the use of omeprazole at a dose of 10 mg once a day in order to prevent the development of relapse of reflux esophagitis in comparison with the standard dose (20 mg). Preliminary short-term (6-month) studies of omeprazole 10 mg have been performed, the results of which suggest that the drug may be effective as a preventive agent for recurrent reflux esophagitis, although the assessment of its effectiveness was based solely on endoscopic criteria4-5.

This study examined whether omeprazole 10 mg once daily was effective in the long-term treatment of reflux esophagitis (over one year) compared with omeprazole 20 mg once daily and placebo in terms of endoscopic recurrence and relapse with symptoms.

Methods

Study design

193 patients took part in the study. All of them had previously achieved healing of reflux esophagitis and disappearance of symptoms of the disease during therapy with omeprazole 20 mg once daily for 4 to 8 weeks. Patients were randomized, double-blind, to receive omeprazole 10 mg once daily, omeprazole 20 mg once daily, or placebo for one year. Endoscopic examination was carried out 3 months after completion of treatment and when symptoms of relapse occurred.

	Omeprazole 10 mg	Omeprazole 20 mg
Demographic characteristics
Patients (n)
Gender (men: women)
Age (g)
Body weight (kg)

Smokers (%)
Drinkers (%)
History of esophagitis
Years since first diagnosis of esophagitis	1 2 (2 6) (n = 52)	1 7 (4 3) (n = 55)	1 2 (2 3) (n = 56)
History of symptoms
Assessment immediately prior to most recent treatment aimed at healing esophagitis
Heartburn (%)
Regurgitation (%)
Dysphagia (%)
Odynophagia (%)
Treatment regimen aimed at healing of esophagitis in the most recent episode*
Omeprazole 20 mg (%)
Omeprazole 20/20 mg (%)
Omeprazole 20/40 mg (%)

Data are presented as numbers or the number of patients in each category or as the mean (standard deviation). *Patients received omeprazole 20 mg once daily for 4 weeks. Patients who were not cured and asymptomatic after 4 weeks received omeprazole 20 mg once daily (omeprazole 20/20 mg) or omeprazole 40 mg once daily (omeprazole 20/40 mg) for subsequent 4 weeks (5-8 weeks).

During patient visits to the clinic (every 3 months), symptoms were recorded: (general health, heartburn, regurgitation, dysphagia), which were assessed on a 4-point scale (0 = no symptoms, 1 = mild symptoms, 2 = moderate symptoms , 3 = severe symptoms).

During the first three months of the study, patients filled out a daily diary recording the severity of symptoms occurring day and night and the number of pills taken. The primary endpoint for diary data was 24-hour symptom freedom. Endoscopic recurrence was defined as recurrence of grade 2–4 esophagitis (see Table 2). Detection of grade 2-4 esophagitis by endoscopic examination in the absence of symptoms or the presence of mild symptoms was considered an asymptomatic relapse. Symptomatic relapse was defined as recurrence of gastroesophageal reflux disease with moderate to severe symptoms.

Patients

The main criteria for inclusion of patients in the study were: age 18-80 years, presence of symptoms of gastroesophageal reflux disease for at least three months, and grade 2-4 reflux esophagitis confirmed by endoscopic examination (Table 2). The main exclusion criteria were: esophageal varices or esophageal stricture, upper gastrointestinal bleeding, septic ulcer, history of gastrointestinal surgery or vagotomy.

	Omeprazole 10 mg	Omeprazole 20 mg
Patients (n) with esophagitis of each severity level
0 degree
1st degree
2nd degree (%)
3rd degree (%)
4 degree (%)
Linear extent of esophagitis (cm)		4 7 (2 1)) (n=67)
Strictures traversable with an endoscope used in adults (%)
Endoscopic signs of Barrett's esophagus (%)

Data are presented as numbers or the number of patients in each category or as the mean (standard deviation). Endoscopic severity grades were defined as follows:

grade - normal mucous membrane.
degree - macroscopic erosions are not visible; erythema or diffuse redness of the mucous membrane; swelling causing enlargement of folds.
degree - isolated round or linear erosions, but without completely involving the circle.
degree - merging erosions involving the entire circle.
grade - obvious benign ulcer.

Barrett's esophagus was defined as the presence of a columnar bordered epithelium extending from more than 3 cm above the proximal edge of the gastric folds (gastroesophageal junction) and around the circumference completely.

At study entry, each patient was confirmed to have healed esophagitis (endoscopy grade 0) and asymptomatic (global evaluation grade 0) after initial treatment with omeprazole. Patients were prematurely excluded from this study if they: (a) had a recurrence of moderate or severe symptoms requiring, in the physician's opinion, the use of a further course of omeprazole therapy; (b) erosive esophagitis (grade 2-4), detected by endoscopic examination after 3 months. All patients provided written informed consent to participate in the study, which was approved by the ethics committee at each institution.

Statistical analysis

According to the results of the primary analysis, the rate of endoscopic remission after 12 months of treatment with omeprazole 10 mg once daily and placebo was comparable.

Endoscopic and symptomatic remission rates with 95% confidence intervals were determined using life table analysis. In addition to the full analysis of 12 months of data, it was important to analyze the first three months.

Additional comparisons (χ2 tests) of remission rates were performed (all treated patients approach, with denominators 60, 10 mg omeprazole; 68, 20 mg omeprazole, placebo), although it is believed that this analysis may underestimate the true number of patients in remission.

A logistic analysis was performed to identify possible predictors of reduced risk of relapse: covariates included duration of the most recent episode of reflux esophagitis; endoscopic grade of esophagitis or severity of symptoms in general at the time of inclusion in the study.

Graphs were constructed using diary data (percentage of patients reporting symptoms during daytime and nighttime). These data are presented cumulatively as the average number of such days per patient; and comparisons between the two groups were made using the χ2 test. Values are presented as mean standard deviation.

results

193 patients were randomized to treatment with omeprazole 10 mg once daily (n = 61), omeprazole 20 mg once daily (n = 69), or placebo (n = 63). Three patients were lost to follow-up (one in the omeprazole 10 mg group, one in the omeprazole 20 mg group, one in the placebo group) due to missing data on treatment efficacy. These patients were excluded from the analysis. At the time of randomization into the study, there were no significant differences between the groups in demographic characteristics, history of esophagitis, and endoscopic findings (Tables 1 and 2).

Examination during clinical visits

Endoscopic recurrence: one to three months

After 3 months, the rate of endoscopic remission according to the survival probability table (the number of patients without esophagitis ≥2 degrees, Fig. 1) was: 79% (95% confidence interval from 69% to 90%) (68% based on all treated patients) - with using omeprazole at a dose of 10 mg once a day; 89% (from 81% to 97%) (76%) - when using omeprazole at a dose of 20 mg once a day; 41% (from 28% to 53%) (23%) - using placebo (10 mg group compared with 20 mg group - the difference is not significant; each p

At the 3-month clinic visit, fewer patients receiving omeprazole 10 and 20 mg were classified as having asymptomatic endoscopic recurrence compared with the placebo group. Of the patients with asymptomatic relapse: 2 of 5 patients received omeprazole 10 mg, 1 of 3 received omeprazole 20 mg, and 1 of 3 received placebo. There was an association between relapse and mild symptoms.

Relapse with symptoms: one to three months

After 3 months, the rate of symptomatic remission according to the survival probability table (number of patients without symptoms or with mild symptoms, Fig. 3) was: 91% (range 84% to 99%) (78% based on all patients treated) - with use omeprazole at a dose of 10 mg once a day; 94% (from 88% to 100%) (85%) - when using omeprazole at a dose of 20 mg once a day; and 63% (from 55% to 76%) (48%) - when using placebo (10 mg group compared with 20 mg group - the difference is not significant; each p

Relapse with symptoms: one to 12 months

At 12 months, the rate of symptomatic remission according to the survival probability table (number of patients without symptoms or with mild symptoms, Fig. 3) was: 77% (64% to 89%) (78% based on all patients treated) - with use omeprazole at a dose of 10 mg once a day; 83% (from 73% to 93%) (82%) - when using omeprazole at a dose of 20 mg once a day; and 34% (from 16% to 52%) (45%) - when using placebo (10 mg group compared with 20 mg group - the difference is not significant; each p

Logistic analysis

The determining factors for reducing the likelihood of endoscopic recurrence were: treatment (omeprazole 20 mg > omeprazole 10 mg > placebo; p

Factors that were most predictive of a reduced risk of symptomatic relapse were: treatment (omeprazole 20 mg > omeprazole 10 mg > placebo; p

Survival time in the study

The interval between randomization and premature discontinuation of treatment or completion of treatment was longer in the omeprazole treatment groups than in the placebo group (247 days - 10 mg group; 263 days - 20 mg group; the difference between these groups is not significant; each p

Symptoms recorded by the doctor

After 3 months, 35 (58%) patients (67% of patients for whom data were available) - when using omeprazole at a dose of 10 mg once daily; 47 - when using omeprazole at a dose of 20 mg once a day, and 17 - when using placebo were completely asymptomatic (10 mg group compared with 20 mg group - the difference is not significant; each p

The number of patients reporting no symptoms at the end of the study was 32 when using omeprazole 10 mg once daily; 46 - when using omeprazole at a dose of 20 mg once a day; 14 - when using placebo (10 mg group compared with 20 mg group - the difference is not significant; each p

In table Figure 3 shows the number of patients who had no specific symptoms after 3 months of treatment and at the end of the study.

	Omeprazole 10 mg	Omeprazole 20 mg

3 month (%)
Completion of study (%)
Regurgitation
3 month (%)
Completion of study (%)
Dysphagia
3 month (%)
Completion of study (%)
Odynophagy
3 month (%)
Completion of study (%)

*p Data are presented as the number of patients without symptoms. Numbers are presented in parentheses based on: (all patients treated (those patients for which data were available))

Patient diary data assessment: one to three months

Patients treated with omeprazole had a greater number of symptom-free days compared with patients treated with placebo (Figure 5). Cumulatively, after 3 months, each patient had an average of 63 such days in the omeprazole 10 mg group and 65 days in the omeprazole 20 mg group, compared with 45 days in the placebo group (the difference was not significant between treatment groups with omeprazole 10 and 20 mg, each p

Portability

There were 91 adverse events reported during the study, 33 in 19 of 61 patients receiving omeprazole 10 mg once daily; 42 in 25 of 69 patients receiving omeprazole 20 mg once daily; and 16 in 13 of 63 placebo-treated patients. The largest number of side effects were recorded from the gastrointestinal tract (13 - in the omeprazole 10 mg therapy group; 12 - 20 mg in the omeprazole 20 mg therapy group; 9 - in the placebo group). The most common symptoms observed were diarrhea and vomiting. From the cardiovascular system (10 - in the omeprazole 10 mg therapy group; 4 - in the omeprazole 20 mg therapy group; 0 - placebo), angina pectoris was most often noted. From the musculoskeletal system (2 - in the omeprazole 10 mg therapy group; 4 - in the omeprazole 20 mg therapy group; 3 - placebo) - joint pain.

Overall, the nature and frequency of adverse events were comparable between treatment groups. Regarding cardiovascular side effects, these were reported in 6 patients receiving omeprazole 10 mg (10 adverse events/one case of premature discontinuation of treatment), in 3 patients receiving omeprazole 20 mg (4 /0), and were not recorded in the placebo group. The most common (8 out of 140) reports were angina pectoris. All cases were associated with previous (before the study) cardiovascular dysfunction, for example, myocardial infarction, arterial hypertension, angina pectoris. No relationship was found between the dose of omeprazole and the incidence of adverse events from the circulatory system. No adverse events were reported in patients receiving placebo.

Discussion

The goals of long-term treatment of reflux esophagitis are:

firstly, a steady weakening of symptoms, up to complete disappearance;
secondly, long-term symptomatic and endoscopic remission.

For each of these targets, treatment response rates were comparable between patients receiving omeprazole 10 mg once daily and omeprazole 20 mg once daily. At the same time, omeprazole in both doses was more effective than placebo.

The use of omeprazole at a dose of 20 mg once daily achieved endoscopic remission after 1 year in 74% of patients, which is comparable to previously published data with this treatment regimen (89%1; 50%2). Despite the comparable effectiveness in preventing verified symptomatic and endoscopic relapses, according to statistical terms between the two omeprazole regimens, there was a numerical superiority when using omeprazole at a dose of 20 mg. This trend indicated a clinically significant difference between treatment regimens. Omeprazole 10 mg can be used as initial therapy. If there is no effect, you should switch to the standard (20 mg) dosage of omeprazole.

The clinical efficacy of omeprazole 10 mg in this study was greater than expected based on clinical trial results8-10. We believe that this discrepancy may be explained by the fact that many early studies involved healthy volunteers rather than patients8–9. Acid suppression achieved with omeprazole 10 mg has recently been shown to be sufficient to promote healing of duodenal ulcers in most patients10. However, in the search for predictors of the effectiveness of omeprazole 10 mg, it seems inappropriate to extrapolate data obtained in the treatment of one disease (active duodenal ulcer) to another disease (inactive reflux esophagitis).

Clinical trials focus on endpoints that are standard assessments of patients within the healthcare system. Initial assessment of relapse and decision on clinical intervention for gastroesophageal reflux disease is made routinely based on the presence/absence of disease symptoms. This practice is fully confirmed by the first three months of therapy, as proven in the present study. Endoscopy was performed after 3 months to determine whether patients continued to have inactive esophagitis. In addition, we took into account the fact that almost one third of the patients randomized to placebo (albeit in the absence of bothersome symptoms) had erosive esophagitis.

Erosive esophagitis in the absence of bothersome symptoms was detected in 13% and 10% of patients receiving omeprazole 10 mg and 20 mg, respectively. This suggests that continued absence of troublesome symptoms is a reliable indicator of sustained endoscopic healing in patients treated with omeprazole. The results support previous work demonstrating a positive association between symptomatic relief and endoscopic healing in the majority of patients treated with omeprazole11.

Hence, patients receiving omeprazole therapy are considered unlikely to require endoscopy to detect relapse, which is an important judgment given today's high demand for endoscopy and may reduce costs to the healthcare system12.

Recurrence with symptoms, even mild severity, may indicate endoscopic recurrence, and such patients require long-term treatment. Moreover, true asymptomatic relapse was rare in this study.

It can be argued that only long-term symptomatic relief is an appropriate goal, but if treatment is ineffective, there remains the suspicion of a high rate of endoscopic recurrence, which may ultimately be associated with complications including the formation of esophageal stricture or columnar metaplasia11.

Clinical studies have demonstrated the effectiveness of omeprazole not only in preventing recurrence of esophagitis, but also in preventing esophageal stricture13 and in inducing regression of columnar mucosa in Barrett's esophagus14. In this regard, long-term use of omeprazole may lead to a reduction in the incidence of complications of gastroesophageal reflux disease.

It was shown that treatment with omeprazole was associated with a decrease in the likelihood of relapse. Data on a longer survival time for patients (more than 2 times compared to placebo) receiving omeprazole therapy is a composite indicator of the therapeutic benefit of omeprazole and its good tolerability.

This study describes maintenance therapy for patients with symptoms of esophagitis. The presence of a placebo control group allows us to understand the natural history of this chronic relapsing disease. The majority of patients receiving placebo relapsed within three months of achieving remission, demonstrating the need for effective long-term treatment for reflux esophagitis. A less carefully selected population than that included in this study would contain patients with typical reflux symptoms but without esophagitis. It is not yet possible to predict which of these endoscopically “negative” patients will subsequently require treatment after achieving a satisfactory result of the initial treatment. In this study, symptomatic recurrence was intense prior to baseline esophagitis severity, while there was a positive association between the likelihood of recurrence and symptom severity immediately before treatment.

Thus, one possible conclusion may be that patients with symptoms of gastroesophageal disease, but without clear endoscopic evidence of esophagitis, are at risk of relapse. In this regard, such patients are candidates for long-term therapy.

As a conclusion, omeprazole at half the standard dose is effective in the long-term treatment of reflux esophagitis, increasing the duration of remission. Omeprazole at a dose of 10 mg per day can be used as initial or maintenance therapy.

C. Male, N. Tootsen, P. Crown, R. Nounford

Literature

Dent J. Australian clinical trials of omeprazole in the management of refiux oesophagitis. Digestion 1990; 47 (suppl 1): 69-71.
Lundell L., Backman L., Ekstrom P., Enander L-K., Falkmer S., Fausa O., et al. Prevention of relapse of reflux oesophagitis after endoscopic healing: the efficacy and safety of omeprazole compared with ranitidine. Scand 7 Gastroenterol 1991; 26: 248-56.
Bate C.M., Richardson P.D.I. Symptomatic assessment and cost effectiveness of treatments for reflux oesophagitis: comparisons of omeprazole and histamine h3-receptor antagonists. Br J Med Econ 1992; 2: 37-48.
Isal J.P., Zeitoun P., Barbier P., Cayphas J.P., Carlsson R. Comparison of two dosage regimens of omeprazole -10 mg once daily and 20 mg weekends - as prophylaxis against recurrence of reflux oesophagitis. Gastroenterology 1990; 98:A63.
Laursen I. S., Bondesen S., Hansen J., Sanchez G., Sebelin E., Havelund T., et al. Omeprazole 10mg or 20 mg daily for the prevention of relapse in gastroesophageal reflux disease? A double-blind comparative study. Gastroenterology 1992; 102:A109.
Bate CM, Booth SN, Crowe JP, Hepworth-Jones B, Taylor MD, Richardson PDI. Does 40 mg omeprazole daily offer additional benefit over 20 mg daily in patients requiring more than 4 weeks of treatment for symptomatic reflux oesophagitis? Aliment Pharmacol Ther 1993; 7:501-8.
Bate CM, Richardson PDI. A one year model for the cost effectiveness of treating reflux oesophagitis. Br Jr Med Econ 1992; 2:5-11.
Hemery P, GalmicheJP, Roze C, IsalJP, Bruley des Varennes S, Lavignolle A, et al. Low dose omeprazole effects on gastric acid secretion in normal man.\Gastroenterol Clin Biol 1987; 11: 148-53.
Sharma BK, Walt RP, Pounder RE, De Fa Gomes M, Wood EC, Logan LH. Optimal dose of oral omeprazole for maximum 24 hour decrease in intragastric acidity. Gut 1984; 25: 957-64.
Savarino V, Mela GS, Zentilin P, Cutela P, Mele MR, Vigneri S, et al. Variability in individual response to various doses of omeprazole. Dig Dis Sci 1994; 39: 161-8.
Green J.R.B. Is there such an entity as mild oesophagitis? European J7ournal of Clinical Research 1993; 4: 29-34.
Bate CM, Richardson PDI. Clinical and economic factors in the selection of drugs for gastroesophageal reflux disease. Pharmaco Economics 1993; 3:94-9.
Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, et al. A comparison of omeprazole and ranitidine in the prevention of recurrence of benign oesophageal stricture. Gastroenterology 1994; 107: 1312-8.
Gore S, Healey CJ, Sutton R, Eyre-Brook IA, Gear MWL, Shepherd NA, et al. Regression of columnar lined (Barrett's) oesophagus with continuous omeprazole therapy. Aliment Pharmacol Ther 1993; 7: 623-8.

medstrana.com

Medicines for esophagitis

Published: August 13, 2015 at 04:21 pm

For inflammation of the mucous membrane of the esophagus, along with the regimen and diet, drug treatment of esophagitis is used. The choice of medication for esophagitis depends on the type of disease and the nature of the disease. For catarrhal, erosive and pseudomembranous esophagitis, antacid medications are prescribed. Drugs to normalize gastric and intestinal motility and reduce hydrochloric acid levels are prescribed in the treatment of this disease. With the development of abscess and phlegmon of the esophagus, as well as the acute form of the disease, antibacterial therapy is prescribed, combining large doses of antibiotics with a wide spectrum of action.

Drugs for esophagitis

Modern pharmacology offers a huge number of drugs used for esophagitis, but they differ in effectiveness and method of application. The success of drug treatment primarily depends on the correct identification of the necessary drugs and the regimen for their use. To avoid undesirable consequences, you must carefully read the instructions, paying special attention to interactions with other medications and conditions of use for pregnant women.

Prokinetics, antacids and alginates are used to eliminate the clinical manifestations of this disease, as they are symptomatic medications. There are also medications, such as Lanzoptol, which reduce the acidity of gastric juice, protecting the esophageal mucosa from irritation. H2 receptor blockers are highly effective in eliminating inflammatory processes and reducing the severity of symptoms. Drugs for the treatment of esophagitis are available in different forms, but generally for esophagitis, tablets are the most common and convenient form.

Omeprazole for esophagitis

The action of Omeprazole begins after exposure to the acidic environment characteristic of the stomach. Penetrating deep into the cells responsible for the production of gastric juice and the enzyme that breaks down proteins, the medicine has a regulatory effect on these processes. The most modern antisecretory drug suppresses the production of hydrochloric acid while simultaneously reducing the level of its activity. The main culprit of reflux esophagitis is Helicobacter pylori bacteria, and Omeprazole has a bactericidal effect.

The medicine, produced in the form of transparent capsules, is used orally. However, if this cannot be done, an internal drug treatment regimen is used. The effect of Omeprazole manifests itself very quickly, literally an hour after administration and continues throughout the day. Restoration of hydrochloric acid production in full is observed five days after completion of the course of drug treatment. Considering that this medicine has many side effects, you should never take Omeprazole without first consulting your doctor. If the cause of the disease is the microorganism Helicobacter pylori, then the tablets are taken according to a certain regimen.

Almagel for esophagitis

Among drugs that have an antacid, astringent and enveloping effect, Almagel for the treatment of esophagitis can be named among the first. The aluminum hydroxide contained in Almagel is converted into aluminum chloride under the influence of hydrochloric acid, minimizing the harmful effects of the acid. Magnesium hydroxide, which is part of Almagel, in addition to neutralizing acid, disavows the ability of aluminum chloride to provoke constipation. In addition, D-sorbitol, also included in the drug, increases bile secretion and acts as a laxative. Uniform regulation of acidity does not cause flatulence and disturbances in water-electric balance. Benzocaine, which is part of it, eliminates pain.

In the treatment of chronic esophagitis caused by Helicobacter pylori, doctors call De-Nol one of the most effective drugs. Its advantages include:

By increasing the production of mucus and bicarbonates, the medicine promotes the rapid formation of new tissue in damaged areas.
The main advantage of De-Nol's properties is that it prevents the production of substances that have a destructive effect on the mucous membrane.
De-Nol, when compared with other drugs, much more activates the movement of blood through the capillaries, increasing their blood supply.

The main active ingredient of the drug is bismuth tripotassium dicitrate, which has an astringent, antimicrobial and gastrocytoprotective effect; the ability of the tablets to dissolve well in the stomach mucus, increases the level of impact on pathogens directly in the shell itself. A certain risk of side effects is associated with long-term use of the drug and the accumulation of bismuth.

The need to use antibiotics for esophagitis is caused by a purulent-inflammatory process accompanied by severe pain. At the same time, with long-term and massive antibiotic therapy, the development of candidal esophagitis is possible. In these cases, antifungal drugs are additionally prescribed.

Motilium for esophagitis

The properties of Motilium to enhance the tone and motor activity of the smooth muscles of the stomach, combined with an increase in the tone of the lower esophageal sphincter and antiemetic effect, make it indispensable for eliminating the symptoms of esophagitis and the causes of the disease. The use of Motilium for internal bleeding, pituitary disease and for the treatment of children under five years of age is strictly prohibited.

The herbal medicine Iberogast has:

anti-inflammatory effect;
restores muscle tone, which ensures normal movement of food;
restores mucosal health by inhibiting the growth of Helicobacter pylori, reducing acidity and improving the properties of gastric mucus.

The main goal of conservative treatment of reflux esophagitis is to prevent the effect of hydrochloric acid on the stratified squamous epithelium of the esophagus.

Treatment of reflux esophagitis consists of three components. First, to prevent gastroesophageal reflux, the patient is advised to raise the head of the bed and not lie down immediately after eating. In addition, to prevent the release of hydrochloric acid in response to food intake, the patient should not eat anything 3 hours before bedtime.

Secondly, to reduce the acidity of gastric contents, antacids, H2-blockers or H+,K+-ATPase inhibitors are prescribed. Antacids containing calcium should be avoided, as it stimulates gastrin secretion and, as a result, hydrochloric acid secretion. Antacids are used whenever heartburn occurs. If antacids cause diarrhea in the patient or he has to take them too often, H2 blockers are prescribed 2 times a day to suppress gastric secretion for a longer period (6 hours or more). If H2 blockers do not help or esophagoscopy reveals moderate or severe esophagitis, H+,K+-ATPase inhibitors are indicated. Omeprazole and lansoprazole suppress the secretion of hydrochloric acid much more strongly than H2-blockers.

In severe esophagitis, omeprazole is more effective than H2 blockers: 90% of patients recover within 12 weeks. The FDA has now approved long-term use of H+,K+-ATPase inhibitors.

The third component of the treatment of reflux esophagitis is increasing pressure in the area of the lower esophageal sphincter; this is necessary if the patient, despite taking H2-blockers or H+,K+-ATPase inhibitors, continues to have gastroesophageal reflux at night. Metoclopramide is a powerful dopamine receptor blocker approved for use in diabetic gastric paresis. It increases the tone of the lower esophageal sphincter for 2 hours and accelerates gastric emptying. Metoclopramide is prescribed 10 mg orally before each meal and at night, usually in combination with H2 blockers or H+, K+-ATPase inhibitors. Side effects (anxiety, tremor, parkinsonism and late neuroleptic hyperkinesis) are observed in 25-50% of cases.

Such intensive treatment is rarely required; For most patients, it is enough to sleep with a high headboard, follow a diet (do not consume foods and drinks that reduce the tone of the lower esophageal sphincter) and take antacids after meals.

Conservative treatment of reflux esophagitis depending on its severity

1. Mild esophagitis: unchanged mucosa

Diet: Avoid substances that reduce the tone of the lower esophageal sphincter.
Antacids: aluminum hydroxide/magnesium hydroxide, 30 ml after meals and at night (for chronic renal failure, only aluminum hydroxide is used)

2. Moderate esophagitis: mucosal erosions

Diet
Raising the head of the bed
H2-blockers, 2 times a day for 12 weeks: cimetidine 400 mg, ranitidine 150 mg, famotidine 20 mg or nizatidine 150 mg

3. Severe esophagitis

Diet
Raising the head of the bed
H+, K+-ATPase inhibitors, 2 times a day for 8 weeks.

Medicines used in the treatment of reflux esophagitis

Cimetidine 400 mg 2 times a day, the proportion of those recovered after 8 weeks is 30-50%,
Ranitidine 150 mg 2-4 times a day, the proportion of those recovered after 8 weeks is 30-50%,
Famotidine 20-40 mg 2 times a day, the proportion of those recovered after 8 weeks is 30-50%,
Nizatidine 150 mg 2 times a day, the proportion of those recovered after 8 weeks is 30-50%,
Omeprazole 20 mg once a day, the proportion of those recovered after 4 weeks is 75-85%,
Lansoprazole 30 mg once a day, the proportion of those recovered after 4 weeks is 75-85%.

For erosions and ulcers of the esophagus, the dose may be higher, treatment can be continued for up to 12 weeks.