Omeprazole was the first proton pump inhibitor developed and this group of drugs has shown significant improvement on acid reflux treatment and gastric acid problems.

These proton pump inhibitors stop the proton pump producing acid in the stomach. This pump is present in the parietal cells of the gastric lining and these drugs work on the final stage of gastric acid production by these cells.

By stopping acid production, these drugs are very effective in relieving symptoms related to acid in the stomach and esophagus. Omeprazole 20mg produces 80% healing rate after 8 weeks for mild esophagitis, and omeprazole 40mg for severe esophagitis has a 63% healing rate after 4 weeks and 90% after 8 weeks.

Omeprazole has a long half life and one dose will maintain acid suppression for 24 hours. We know that for healing, acid suppression has to be maintained for over 24 hours and omeprazole is an ideal acid reflux treatment option to meet this. Compliance is also better.

Omeprazole is effective in all grades of acid reflux but there remains a rare few that do not significantly benefit and this is because high acid suppression is not achieved.

Various test show superiority over ranitidine in acid reflux treatment. Results from a trial with omeprazole 40mg and ranitidine 300mg twice a day on severe cases of GERD showed omeprazole 40mg healed over 90% of patients after 12 weeks compared to under 50% on ranitidine over the same time interval.

Omeprazole is well tolerated. The side effects uncommonly reported are skin rashes, diarrhoea and headache. Omeprazole can affect warfarin and phenytoin. There has been concern about long tern suppression of acid in the stomach and fear than it may lead on to serious disease such as tumours but trial results have not shown any worrying changes.

Dr. Phil Hariram,