Omeprazole - does it continue to work

[medway]

I am currently taking Omeprazole twice a day post operatively to stop or reduce stomach acid. I have been taking these for 14 months. I have been told that Omeprazole stops working after some time.

Is this correct?

[yorkshirerose]

Hi Medway

I will be interested in the reply to this as I have been taking it for two and a half years, I have lowered the dose, but find if I forget to take it I get really bad burning sensation in my throat within a couple of hours.

Can I add another question to this for you with more knowledge out there, I was told that long term use of PPI's can lead to brittle bones. Any advice?

Edwina

[AndrewB]

I have been on omeprazole for at least 10 years and yes it continues to work. I'd also like to hear the answer to "brittle bones" I am seeing my surgeon for a check up on Thursday so will ask him.

[werfvan5]

Im sure like ALL medication long term use makes them less effective, After 7 years on Omeprazole i find myself "upping" my dose on more than one occastion ......i dont stay on the same dose when i keep getting re-occuring reflux ,thinking it will go away,it doesnt ,taking extra for a short time gets it back on course ....

[sensus]

I have been taking 2 x 20mg omeprazole tabs a day for 4 years since my op and if I stop then pain quickly returns. So my advice is to keep taking it and use Gaviscon in between at any time when acid returns.

[midnightangler]

I have been taking omeprazole for 13 years now, that's nine years pre op and four post op. Have found that I have needed to up the dosage over time. Have tried to lower the dosage and vary times times taken, but did not work. Used to take one 20 mg a day but re-flux started to occur after 14-16 hours so started taking 10 mg every twelve hours, but after a few months had to increase dose to 40 mg a day. For the last year I had been getting re-flux of a night and started taking 40 mg in the evening and another 20 mg in the morning for the last couple of weeks. Did try only taking the 40 mg evening dose last Saturday but by midday Sunday I was suffering with bad re-flux!

[chris_usa]

There is some evidence that long-term use of PPIs (ie Prilosec, Prevacid, Nexium, and a few others) can lead to brittle bones and hip fractures. The theory behind this is that an acidic environment is required for the absorption of calcium in the stomach, and PPIs do such a great job of lowering the acid level that calcium is not properly absorbed.

I stress that there is disagreement in the medical community about the clinical impact of this. Some practitioners check calcium and magnesium levels on patients on long-term PPI treatment, but others see that there is no clinical significance.

I would say that it is appropriate to discuss this issue with your provider, and they can look at your risk factors and see the appropriateness of such monitoring.

As a patient, I was on high-dose PPIs for about 10 years between my esoph myotomy and esophagectomy. They kept incraesing the dose with limited benefit, but after the esophagectomy I have no need to take them. I am currently awaiting results from a DEXA (bone) scan to see the status of my bones. I only take ranitidine 150mg at bedtime now to lessen nightime reflux and aspiration.

[Hidden]

PPI medication (eg omeprazole, lansoprazole) works by partially or wholly switching off the production of stomach acid, but that in turn does affect the way in which calcium is absorbed into the body, and this may, long term, affect bone strength and be an issue with potential osteoporosis. It is not a big issue compared to the problems you have been through, but it may mean that extra precautions to counteract this effect have to be taken.

PPIs are safe and very commonly prescribed but the medical community are becoming aware of the long term effects - most people take them when their digestive systems have not been surgically shortened, so absorption of all sorts of minerals and vitamins may not be the issue for them as it is for us. It is not a bad thing to review any medication after a while - in consultation with your doctor. We get prescribed things because generally they will do us more good than harm, but reviewing things is a good idea in principle.

If osteoporosis is a worry, you can ask for a bone density scan, and, if there is a problem, you may well be prescribed calcium supplements and/or vitamin D. Sometimes these might be given in a different form from the orthodox pills because of our difficulty in absorbing medication.

The other thing to bear in mind is that reflux may not be acid - it might be bile, which comes from the liver / bile duct which may also have been altered in your surgery. Bile tastes even worse and is an alkali so PPIs will not counteract it, and neither will antacid medication.

If you stop taking PPIs your body sometimes reacts with a 'bounce' for a week or two and gives you reflux problems because of the effects of stopping the medication. When this happens you can try gaviscon, which is an alginate. It works differently, by creating a protective raft in your system for a few hours.

[medway in reply to Hidden]

Thanks Alan. Very illuminating. In my case with some stomach and no reflux (Merendino interposition), the omeprazole I think is to prevent acid damage to the extensive scaring which must be there with 1/3 stomach removed and jejunum added but I'm told jejunum is quite resistant to acid attack being in the digestive system where it receives a mixture of food and acid normally.

I wasn't aware of the calcium deficiency problem, so I'll ask my local doctor to keep an eye on this.

[yorkshirerose]

Thanks Alan, thats my question answered, don't know what we would do without you guys out there

Edwina x

[jay2908]

I too had been on omprepazole for 4 years and attempted many times to ween myself off it. I had been informed by many surgeons and medics that once you have a gastorectomy and vegotomy your body in incapable of producing any acid. Therefore the reflux I was feeling was bile related. Having read a few articles on PPIs I discovered that they can also reduce bile production.

The approach I took was to switch between two PPIs on alternate days, knowing that the second PPI has been shown to be less effective (ranitadine - less eff effective than omeprazole). Note that I had to get agreement from my GP to get both drugs prescribed at the same time).

Eventually I got myself off of omeprazole and on to ranitadine. I then reduced the dose of ranitadine over 4 weeks and eventually PPI free. I have to say that it took quite few attempts before I decided to use two drugs, I just could not get off omprezole alone and this is related to the bounce back of the bile.

During this time I also avoided anything that could irritate my digestive system such as chillies, spicy foods and alcohol and used paracetamol and Antepsin to manage the pain.

Needless to say, please speak to your doctors before changing your drugs.

[VickiSavage in reply to jay2908]

Thanks everybody for these answers. Am seeing GP on Thursday as it's been 4 and half years since Ivor Lewis and keen to lose the Lanzoprazole 2 x 30mg) but suffer badly with cough in early hours of morning causing lack of sleep and also cough late afternoon. Will discuss the bone density issue as female 55yr so can be a problem for later life - which frankly I'm eternally grateful that I now have to look forward to!