Omeprazole withdrawal effects

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Omeprazole Withdrawal Effects: Gastric Acid, Symptoms, and Biochemical Changes

Rebound Acid Hypersecretion and Symptom Recurrence

Sudden withdrawal of long-term omeprazole therapy can lead to a quick increase in gastric acid production. In patients with reflux oesophagitis, stopping omeprazole resulted in a significant rise in basal acid output within 10 days, along with a rapid return of reflux symptoms and oesophagitis as seen both endoscopically and symptomatically . This phenomenon, known as rebound acid hypersecretion (RAH), has also been observed in animal studies, where abrupt cessation of omeprazole led to evidence of gastric hyperacidity .

Changes in Serum Gastrin Levels

During omeprazole treatment, serum gastrin levels are elevated due to the suppression of stomach acid. After stopping omeprazole, these gastrin levels decrease quickly, returning to normal within about 10 days . This pattern was also seen in animal studies, where prolonged omeprazole use caused hypergastrinemia, which normalized after withdrawal .

Effects on Gut Microbiota in Cirrhosis

In patients with cirrhosis, omeprazole use is linked to changes in gut microbiota, specifically an increase in oral-origin bacteria and a decrease in beneficial gut bacteria. Withdrawal of omeprazole in these patients led to a significant reduction in oral-origin microbial taxa, suggesting that stopping the drug can help restore a healthier gut microbiome .

Renal Effects and Acute Interstitial Nephritis

Although not a direct withdrawal effect, it is important to note that omeprazole has been associated with acute interstitial nephritis (AIN), a serious kidney condition. In reported cases, AIN was diagnosed after omeprazole use, and withdrawal of the drug, along with corticosteroid therapy, led to recovery of kidney function in most patients . Recurrence of AIN was universal upon rechallenge with omeprazole .

Summary

Withdrawal of omeprazole, especially after long-term use, can cause a rapid increase in stomach acid production and a quick return of symptoms in patients with acid-related disorders 12. Serum gastrin levels, which are elevated during treatment, normalize soon after stopping the drug 12. In patients with cirrhosis, omeprazole withdrawal can improve gut microbiota composition . While omeprazole is generally well tolerated, clinicians should be aware of potential kidney complications and the need for careful management during withdrawal .

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Most relevant research papers on this topic

Temporary cessation of long-term maintenance treatment with omeprazole in patients with H2-receptor-antagonist-resistant reflux oesophagitis. Effects on symptoms, endoscopy, serum gastrin, and gastric acid output.

Stopping long-term maintenance treatment with omeprazole in patients with H2-receptor-antagonist-resistant reflux oesophagitis leads to rapid normalization of serum gastrin levels and recurrence of reflux symptoms and oesophagitis within 10 days.

Non-RCT

1990·

33citations

·E. Klinkenberg‐Knol et al.

A Prospective, Placebo‐Controlled Pilot Evaluation of the Effect of Omeprazole on Serum Calcium, Magnesium, Cobalamin, Gastrin Concentrations, and Bone in Cats

Prolonged proton pump inhibitor treatment in cats leads to hypergastrinemia and abrupt withdrawal may result in rebound acid hypersecretion.

RCTAnimal Study

2016·

29citations

·E. Gould et al.

Acute interstitial nephritis due to omeprazole

Omeprazole use can cause acute interstitial nephritis, with most patients recovering normal renal function after withdrawal and corticosteroid therapy.

Case ReportHighly Cited

2001·

122citations

·R. Myers et al.

The use of omeprazole to alleviate stomach ulcers in swine during periods of feed withdrawal.

Omeprazole effectively prevents some gastric ulceration in pigs during feed withdrawal, but not all, suggesting other components like bile acids play a role in tissue damage.

RCTAnimal Study

2000·

13citations

·R. Friendship et al.

Proton Pump Inhibitor Initiation and Withdrawal affects Gut Microbiota and Readmission Risk in Cirrhosis

PPIs increase readmission risk and gut microbiota composition in cirrhosis, and their withdrawal can lead to a reduction in oral-origin microbial taxa.

Observational StudyHighly Cited

2018·

104citations

·J. Bajaj et al.

Loperamide and P‐glycoprotein modulator in opioid detoxification

The new opioid withdrawal protocol using loperamide and P-glycoprotein inhibitor (omeprazole) is effective in reducing opioid-related health risks.

Case Report

2021·

0citations

·Mohamed Al Garhy et al.

Pharmacological Effects and Toxicogenetic Impacts of Omeprazole: Genomic Instability and Cancer

Long-term use of omeprazole may induce genomic instability and increase the risk of certain types of cancer, requiring adequate precautions.

Systematic ReviewRigorous Journal

2020·

21citations

·M. F. C. J. Paz et al.

In vivo and in vitro protective effects of omeprazole against neuropathic pain

Omeprazole reduces neuropathic pain and protects against chronic constriction injury-induced damage by preventing proinflammatory cytokine release, enhancing anti-oxidant defense, and maintaining nerve integrity.

Non-RCTAnimal Study

2016·

57citations

·Sanjay K. Chanchal et al.

Death attributed to severe anaphylactic reaction due to omeprazole

Omeprazole can cause severe anaphylactic reactions, leading to death in a 61-year-old female patient.

Case Report

2017·

0citations

·Zhi-guang Qiu et al.

Prospective Randomized Controlled Clinical Trial of the Long-Term Effects of Omeprazole on Healthy Dogs

Long-term (60 days) use of omeprazole in healthy dogs leads to a significant increase in serum gastrin levels, potentially increasing the risk of gastric hyperplasia or cancer.

RCTAnimal Study

2024·

3citations

·Laura Gil-Vicente et al.

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