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Ulcer Treatment Using Omeprazole And Other Proton Pump Inhibitors (PPI)

By on October 19, 2012

Omeprazole is a type of medication often prescribed for treatment of gastro-intestinal conditions like ulcer, gastro-esophageal reflux or Zollinger-Ellison syndrome. Omeprazole and other drugs in the proton pump inhibitors category can have a beneficial effect on patients suffering from stomach or duodenal ulcers, and associated with antibiotics, can even cure ulcer.

How does omeprazole work?

Omeprazole has a very specific mechanism that works to reduce the acidic gastric secretion, by inhibiting the activity of the proton pump. This action is reversible, and the gastric secretion returns to normal once the medication is no longer administered.

Ulcer Treatment Using Omeprazole And Other Proton Pump Inhibitors (PPI)

By: John

It usually takes a simple administration per day to significantly reduce gastric secretion and allow the ulcer to heal properly. Its effect depends on the dose; so the higher the dose, the more inhibited the gastric secretion will be. More importantly, it reduces acidic secretion both during the day and night, and it will usually take about 3-4 days to reach its maximum effect. It also has effects on Helicobacter pylori – a bacterium that is present in 70-90% of the people that have developed some type of ulcer. Helicobacter pylori along with highly acidic secretions are the main factors that can produce and aggravate ulcer. The bacterium is also known to be related to the development of gastric cancer.

Studies have shown that omeprazole has a bactericidal effect on Helicobacter pylori bacteria, so associating omeprazole with antibiotics leads to a rapid disappearance of ulcer symptoms. This also plays an important part in diminishing any of the possible complications of ulcer, for example bleeding.

How can omeprazole be used to treat ulcer?

For omeprazole to have a beneficial effect on ulcers, physicians recommended a dose of 20 mg each day. Relief from unpleasant symptoms can be acquired fast and most of the times it takes about four weeks to show considerable results. Still, for some of the patients, especially those who have severe forms of ulcer, it may take more than the initial four weeks for the signs to disappear. In this case, it is recommended to continue the treatment for another four weeks, after which it is necessary for the patient to be re-evaluated.

If  the response to treatment is still not satisfactory, the dose should be increased up to 40mg each day, and the patient must be evaluated after another eight weeks. Ulcer may or may not be associated with the presence of Helicobacter pylori bacteria, so there are different approaches to the treatment of each case.

If the bacteria are present, omeprazole would not be efficient enough on its own, so it is necessary to associate it with antibacterial agents like clarithromycin and amoxicillin. This type of drug association (also known as “triple therapy”) should be administered twice a day for a week.

There is also another type of therapy – the double therapy that associates omeprazole with either amoxicillin or clarithromycin. This type of therapy should last for about two weeks. The treatment should always be prolonged if the symptoms persist after the initial couple of weeks.

Omeprazole can also be used to prevent ulcer recurrence if an individual has already suffered from it, or to protect the stomach, especially if the patient is undergoing treatment using non-steroidal anti-inflammatory (NSAIDs) medication.

Side effects that can occur during treatment:

Even though omeprazole is usually well tolerated, there can always be side effects but most of them are reversible and not life threatening.

The types of side effects that can occur are:

  • Gastro-intestinal:  diarrhea or constipation, severe nausea that can lead to vomiting and abdominal pain. Some of these symptoms can become confusing for the patient, since ulcer itself can cause them.  Gastric candidiasis is also more likely to occur during treatment with omeprazole.
  • Neurological: numbness, headaches or migraines, somnolence or insomnia, and sometimes dizziness.
  • Dermatological: rashes, itchiness, increased sensitivity to light, hair loss.
  • Hematological: leukopenia, agranulocytosis and possibly thrombocytopenia. These types of side effects rarely occur during treatment.

There can be a series of other side effects like fever, anaphylaxis, or other hypersensitivity reactions, though these have a very low probability of happening during treatment. High doses or prolonged treatment (lasting for more than one year) is likely to increase the risk of osteoporosis or bone fractures.

It is important for the patient to have some tests done before beginning treatment with proton pump inhibitors, so any malignant process can be excluded.

Also, omeprazole is not recommended during pregnancy, although studies have not shown any possible toxic effect on the fetus.

Other proton pump inhibitors used in ulcer treatment

Pantoprazole (Protonix) – is another drug from the PPI category that can successfully be used in the treatment of stomach or duodenal ulcer. Although from the same class as omeprazole, it is not the first choice for treating this type of gastro-intestinal disorder and is mostly preferred for preventing ulcers, or for protection against NSAID medication.

It is not recommended for people who suffer from serious liver problems, because it can increase the levels of hepatic enzymes. Also, people that have low levels of vitamin B12 should not take pantoprazole simultaneously with B12, because it reduces stomach acidity and decreases absorption.

Pantoprazole can mask symptoms of stomach cancer, leading to a late diagnosis, so all blood tests should be done before starting treatment.

Side effects of pantoprazole include severe allergic reactions (edema, swelling of the tongue, difficulty breathing) and also some severe dermatological problems (blisters,   erosion to the point of light bleeding). If any of these symptoms occur, the patient should immediately be treated.

Lansoprazole (Prevacid) – is an over-the-counter medication, from the same PPI class as omeprazole and pantoprazole, also used in ulcer treatment. It can also be used with antibiotics, in double or triple therapy, in order to kill Helicobacter pylori bacteria. It is usually used along with amoxicillin and clarithromycin, twice a day for 2 weeks. It can interact with a series of other medication like antifungals, antibiotics, purgatives, decreasing their absorption. Most of the side effects are similar to those of other proton pump inhibitors and include: liver dysfunction, rashes, hematological disorders, hypersensitivity reaction, and many others.

Rabeprazole (AcipHex) – PPI drug used for short term ulcer treatment, especially in duodenal ulcers. It must not be used during pregnancy or lactation, because the risk of affecting the baby has not been ruled out yet. Its usage is restricted to people under the age of 18, or those who suffer from acute liver failure.

Side effects include anxiety, headache (the most common side effect as according to a study), dry mouth, insomnia, dizziness.

There are a number of other PPIs that are not used  commonly, but have the same main effects as omeprazole; these include: Dexlansoprazole( brand name Kapidex), Esomeprazole (Nexium) and Illaprazole (Illapro).