Proton pump inhibitors: beware of side effects of omeprazole and derivatives

By Cristiano Antonino On Feb 23, 2023

Proton pump inhibitors (omeprazole, lansoprazole, esomeprazole, pantoprazole and rabeprazole) are drugs commonly used especially in the short and long-term therapy of gastroesophageal reflux disease, in the eradication of Helicobacter pylori, in the therapy of peptic ulcer and as ‘gastroprotectors’ in patients taking steroids or non-steroidal anti-inflammatory drugs for other pathologies

Over-the-counter (OTC) formulations of these drugs have recently been introduced to the market for the treatment of dyspepsia.

Omeprazole and gastroesophageal reflux

Esophageal or gastroesophageal reflux is a condition in which the liquids contained in the stomach go back up into the esophagus: it is a situation which, in small quantities, is considered normal, but when this disorder occurs frequently and involves obvious symptoms, then This is referred to as gastroesophageal reflux disease.

The causes of reflux can be of various types and it is important to identify them in order to obtain a correct diagnosis of the disease and to avoid possible complications such as, for example, the more serious one which is Barrett’s esophagus.

The drugs used to treat esophageal reflux are, in fact, proton pump inhibitors such as omeprazole and pantoprazole, but it is necessary to pay attention to the possible side effects of this type of drug.

Omeprazole, the side effects of proton pump inhibitors

However, a recent review of the literature has shown that, like all medicines, they are certainly not free from side or unwanted effects and in particular:

higher incidence of headache, rash and short-term diarrhea for dyspepsia therapy compared to H2 blockers (ranitidine and others)
two studies observed a higher incidence of osteoporosis and hip fractures in patients treated with pump inhibitors, even if a cause-and-effect relationship was not fully demonstrated (in particular due to the lower absorption of calcium and magnesium in patients treated) which, however, appears plausible
iron malabsorption in patients already known to have iron deficiency as occurs in patients with atrophic gastritis
reduced absorption of vitamin B12
the use of pump inhibitors is associated with a higher incidence of gastric cancer, however, most cancers diagnosed in patients on therapy are detected within a year of therapy, suggesting more than a cause-and-effect relationship, a masking of symptoms by the drug
major intestinal infections in particular from Salmonella and Campylobacter probably favored by the marked inhibition of gastric acidity
increased incidence of microscopic and collagenous colitis in patients on therapy

In conclusion, the use of these drugs, extremely effective if used well, should always be limited to patients in whom the indication is correct, at the minimum effective dosage and for the shortest time necessary according to the doctor’s indications and never self-prescribed or used for no specific reason.

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