How effective is omeprazole for treating hiatal hernia. What dosage of omeprazole is typically prescribed for hiatal hernia. What do patient reviews say about using omeprazole for hiatal hernia. Are there any side effects or precautions to be aware of when taking omeprazole for hiatal hernia.

Understanding Hiatal Hernia and Its Treatment Options

A hiatal hernia occurs when part of the stomach pushes upward through the diaphragm, the muscular wall separating the chest cavity from the abdomen. This condition can cause symptoms like heartburn, chest pain, and difficulty swallowing. While not all hiatal hernias require treatment, medication is often prescribed to manage symptoms and prevent complications.

Proton pump inhibitors (PPIs) like omeprazole are commonly used to treat hiatal hernia symptoms by reducing stomach acid production. But how effective is omeprazole specifically for hiatal hernia, and what do patients say about their experiences with this medication?

Omeprazole: Mechanism of Action and Uses

Omeprazole belongs to a class of drugs called proton pump inhibitors (PPIs). It works by blocking the enzyme in the wall of the stomach that produces acid. By reducing acid production, omeprazole can help alleviate symptoms associated with various gastrointestinal conditions, including:

• Gastroesophageal reflux disease (GERD)
• Peptic ulcers
• Zollinger-Ellison syndrome
• Erosive esophagitis
• Hiatal hernia

While omeprazole is not specifically approved for treating hiatal hernia, it is often prescribed off-label to manage the acid reflux symptoms that frequently accompany this condition.

Dosage Considerations for Hiatal Hernia Treatment

The appropriate dosage of omeprazole for hiatal hernia can vary depending on several factors, including the severity of symptoms and the presence of complications. Typically, doctors may prescribe:

• 20-40 mg once daily for 4-8 weeks for symptom relief
• Maintenance doses of 10-20 mg daily for long-term management

It’s crucial to note that the presence of a hiatal hernia may affect the required dosage. A study published in Alimentary Pharmacology & Therapeutics found that patients with hiatal hernia often required higher doses of proton pump inhibitors (like lansoprazole, which is similar to omeprazole) to achieve effective acid suppression compared to those without hiatal hernia.

Does hiatal hernia size affect omeprazole dosage?

The size of a hiatal hernia may indeed influence the required omeprazole dosage. Larger hernias are often associated with more severe symptoms and a higher risk of complications. As a result, patients with larger hiatal hernias might need higher doses or longer treatment durations to achieve symptom control. However, the exact relationship between hernia size and optimal omeprazole dosage is not fully established and may vary on a case-by-case basis.

Patient Reviews: Omeprazole for Hiatal Hernia

According to the reviews summarized in the provided information, omeprazole has received mixed feedback from patients using it for hiatal hernia treatment. The medication has an average rating of 3.2 out of 10 based on 19 reviews, with 16% of reviewers reporting a positive experience and 74% reporting a negative experience.

It’s important to interpret these reviews cautiously, as they represent a small sample size and individual experiences can vary greatly. Factors such as severity of the hiatal hernia, presence of other medical conditions, and proper usage of the medication can all influence a patient’s experience.

Why do some patients report negative experiences with omeprazole?

There could be several reasons for negative reviews of omeprazole in hiatal hernia treatment:

• Inadequate dosage or duration of treatment
• Presence of other underlying conditions not addressed by omeprazole
• Side effects of the medication
• Expectations of complete symptom resolution, which may not be realistic for all patients
• Individual variations in response to the medication

It’s crucial for patients to discuss their concerns and experiences with their healthcare provider to ensure optimal treatment.

Potential Side Effects and Precautions

While omeprazole is generally well-tolerated, like all medications, it can cause side effects in some individuals. Common side effects may include:

• Headache
• Nausea
• Diarrhea
• Abdominal pain
• Dizziness

Long-term use of PPIs like omeprazole has been associated with certain risks, including:

• Increased risk of bone fractures
• Vitamin B12 deficiency
• Increased risk of certain infections
• Potential increased risk of kidney problems

Patients should discuss these potential risks with their healthcare provider and weigh them against the benefits of treatment.

Are there any drug interactions to be aware of when taking omeprazole?

Omeprazole can interact with various medications, potentially altering their effectiveness or increasing the risk of side effects. Some important interactions to be aware of include:

• Clopidogrel (Plavix): Omeprazole may reduce its antiplatelet effect
• Diazepam (Valium): Omeprazole may increase its blood levels
• Cilostazol: Omeprazole may increase its blood levels
• Warfarin: Omeprazole may increase the risk of bleeding
• Methotrexate: Omeprazole may increase its blood levels

Always inform your healthcare provider about all medications, supplements, and herbal products you’re taking to avoid potential interactions.

Alternatives to Omeprazole for Hiatal Hernia

While omeprazole is a common treatment for hiatal hernia symptoms, it’s not the only option available. Depending on the severity of symptoms and individual patient factors, healthcare providers might consider other treatments, including:

• Other proton pump inhibitors (e.g., esomeprazole, lansoprazole)
• H2 receptor blockers (e.g., famotidine, ranitidine)
• Antacids for occasional symptom relief
• Lifestyle modifications (e.g., dietary changes, weight loss)
• Surgical intervention for severe cases

How do H2 blockers compare to PPIs like omeprazole for hiatal hernia treatment?

H2 blockers and PPIs work differently to reduce stomach acid:

• H2 blockers work by blocking histamine, which stimulates acid production
• PPIs like omeprazole directly inhibit the proton pumps that produce acid

Generally, PPIs are considered more effective for long-term acid suppression and healing of esophageal damage. However, H2 blockers may be preferred in some cases due to their faster onset of action or if a patient experiences side effects with PPIs. The choice between these medications should be made in consultation with a healthcare provider based on individual patient factors.

Lifestyle Modifications to Complement Omeprazole Treatment

While omeprazole can be effective in managing hiatal hernia symptoms, combining medication with lifestyle changes can often lead to better outcomes. Some beneficial lifestyle modifications include:

• Eating smaller, more frequent meals
• Avoiding trigger foods (e.g., spicy, fatty, or acidic foods)
• Quitting smoking
• Limiting alcohol consumption
• Maintaining a healthy weight
• Elevating the head of the bed
• Avoiding lying down immediately after meals

Can dietary changes alone manage hiatal hernia symptoms without medication?

For some individuals with mild symptoms, dietary and lifestyle changes may be sufficient to manage hiatal hernia-related discomfort. However, the effectiveness of this approach can vary greatly depending on factors such as:

• The size of the hernia
• The severity of symptoms
• Individual response to dietary modifications
• Presence of other related conditions (e.g., GERD)

Many patients find that a combination of lifestyle changes and medication provides the most effective symptom relief. It’s important to work with a healthcare provider to develop a comprehensive treatment plan tailored to individual needs.

Long-Term Management of Hiatal Hernia with Omeprazole

For many patients, hiatal hernia is a chronic condition that requires ongoing management. Long-term use of omeprazole may be recommended in some cases, but it’s important to regularly reassess the need for continued treatment. Considerations for long-term management include:

• Regular follow-ups with a healthcare provider
• Periodic attempts to reduce or discontinue medication under medical supervision
• Monitoring for potential long-term side effects of PPIs
• Adjusting treatment based on symptom control and quality of life

Is it safe to take omeprazole indefinitely for hiatal hernia?

While omeprazole is generally considered safe for long-term use, indefinite treatment should be approached cautiously. Long-term PPI use has been associated with certain risks, including:

• Increased risk of certain infections
• Potential for vitamin and mineral deficiencies
• Possible increased risk of bone fractures
• Rare but serious side effects such as kidney problems

The decision to continue long-term omeprazole treatment should be made in consultation with a healthcare provider, weighing the benefits of symptom control against potential risks. Regular reassessment of the need for ongoing treatment is important.

When to Consider Surgical Options for Hiatal Hernia

While medication like omeprazole can effectively manage symptoms for many patients with hiatal hernia, some cases may require surgical intervention. Situations where surgery might be considered include:

• Large hernias that are at risk of complications
• Symptoms that are not adequately controlled with medication
• Complications such as strictures or bleeding
• Severe regurgitation affecting quality of life
• Preference for a long-term solution over ongoing medication use

Common surgical approaches for hiatal hernia repair include laparoscopic fundoplication and minimally invasive repair techniques. The decision to pursue surgery should be made in consultation with a gastroenterologist and a surgeon, considering individual patient factors and potential risks and benefits.

How does the success rate of surgical repair compare to long-term medication use?

The success rates of surgical repair and long-term medication use for hiatal hernia can vary depending on several factors:

• Surgical repair often provides more definitive symptom relief, with success rates ranging from 80-90% in carefully selected patients
• Long-term medication use can effectively control symptoms in many patients, but may not address the underlying anatomical issue
• The effectiveness of both approaches can decrease over time, with some patients experiencing symptom recurrence
• Individual patient factors, such as age, overall health, and hernia size, can influence outcomes

Studies comparing long-term outcomes of surgical repair versus medical management have shown mixed results, with some favoring surgery and others showing similar effectiveness. The choice between these approaches should be individualized based on patient preferences, symptom severity, and overall health status.

The Role of Diagnostic Tests in Guiding Hiatal Hernia Treatment

Proper diagnosis and assessment of hiatal hernia severity are crucial in determining the most appropriate treatment approach, including the use of omeprazole. Common diagnostic tests used in the evaluation of hiatal hernia include:

• Barium swallow study
• Upper endoscopy
• Esophageal manometry
• 24-hour pH monitoring
• CT scan or MRI in some cases

These tests can provide valuable information about the size of the hernia, the presence of complications, and the severity of acid reflux, which can guide treatment decisions and help determine the optimal dosage of medications like omeprazole.

How often should diagnostic tests be repeated in patients with hiatal hernia?

The frequency of repeat diagnostic testing for patients with hiatal hernia can vary based on individual circumstances. General guidelines include:

• Repeat endoscopy every 2-3 years for patients with uncomplicated hiatal hernia and well-controlled symptoms
• More frequent testing for patients with persistent or worsening symptoms despite treatment
• Annual endoscopy for patients with Barrett’s esophagus or other complications
• Repeat testing if there are significant changes in symptoms or response to treatment

The decision to repeat diagnostic tests should be made in consultation with a healthcare provider, considering factors such as symptom control, response to treatment, and individual risk factors.

Omeprazole for Hiatal Hernia Reviews

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Brand names:
Prilosec,
Prilosec OTC,
Omesec

Omeprazole
has an average rating of 3.2 out of 10 from a total of 19 reviews
for the
off-label treatment of Hiatal Hernia.
16% of reviewers reported a positive experience, while 74% reported a negative experience.

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3.2/10 average rating

19 ratings from 19 user reviews.

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Hiatal hernia is the key factor determining the lansoprazole dosage required for effective intra-oesophageal acid suppression

Clinical Trial

. 2002 May;16(5):881-6.

doi: 10.1046/j.1365-2036.2002.01248.x.

M Frazzoni 
¹
, E De Micheli, A Grisendi, V Savarino

Affiliations

Affiliation

• ¹ Divisione di Medicina Interna e Gastroenterologia, Ospedale S. Agostino, Modena, Italy. [email protected]

• PMID:

  11966495

• DOI:

  10.1046/j.1365-2036.2002.01248.x

Free article

Clinical Trial

M Frazzoni et al.

Aliment Pharmacol Ther.

2002 May.

Free article

. 2002 May;16(5):881-6.

doi: 10.1046/j.1365-2036.2002.01248.x.

Authors

M Frazzoni 
¹
, E De Micheli, A Grisendi, V Savarino

Affiliation

• ¹ Divisione di Medicina Interna e Gastroenterologia, Ospedale S. Agostino, Modena, Italy. [email protected]

• PMID:

  11966495

• DOI:

  10.1046/j.1365-2036.2002.01248.x

Abstract

Background:

Effective intra-oesophageal acid suppression can be achieved with lansoprazole. The daily dosage could be influenced by the presence of hiatal hernia.

Aim:

To assess the lansoprazole daily dosage required to normalize oesophageal acid exposure in patients with and without hiatal hernia.

Methods:

Fifty patients with complications or atypical manifestations of gastro-oesophageal reflux disease were given lansoprazole, 30 mg once daily. Three to four weeks after the start of treatment, patients underwent oesophageal pH monitoring while on therapy. If the results were still abnormal, the lansoprazole dosage was doubled and 24-h pH-metry was repeated 20-30 days thereafter.

Results:

A 30-mg daily dosage of lansoprazole normalized oesophageal acid exposure in 70% of cases, whilst a 60-mg daily dosage was necessary in the remainder: the two groups differed only in the presence of hiatal hernia (28% vs. 100%, respectively; P=0.000). Effective intra-oesophageal acid suppression was obtained in all 25 patients without hiatal hernia with the 30-mg daily dosage of lansoprazole.

Conclusions:

Hiatal hernia is the key factor determining the lansoprazole dosage required for effective intra-oesophageal acid suppression in complicated and atypical gastro-oesophageal reflux disease. High efficacy of a 30-mg daily dosage of lansoprazole can be predicted in the absence of hiatal hernia.

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Publication types

MeSH terms

Substances

Gastroesophageal reflux disease (GERD). Hernia of the esophageal opening of the diaphragm (HH). | Center for Endosurgical Technologies

Gastroesophageal reflux disease (GERD) is a disease characterized by the reflux of gastric contents into the esophagus.

Hiatal hernia is an enlargement of the hiatus that allows part of the stomach to enter the chest. In 90% hiatal hernia leads to GERD.

40% of people constantly (with varying frequency) experience heartburn, the main symptom of GERD. In general, the prevalence of GERD in Russia among the adult population is 40-60%, and esophagitis is found in 45-80% of people with GERD.

Causes of GERD.

The human stomach contains hydrochloric acid, the walls of the stomach are resistant to acid. The esophagus does not have such stability. The body has a number of mechanisms that prevent the entry of gastric contents into the esophagus. For various reasons, these mechanisms may not be able to cope, and gastric contents enter the esophagus, burning its walls.

D The main symptom of GERD is heartburn,

occurs in 83% of patients. In addition, symptoms of reflux (casting) can be pain in the upper abdomen and behind the sternum, belching, regurgitation of food, and swallowing disorders. GERD can also lead to disruption of the heart and lungs. Symptoms may be aggravated by violation, alcohol intake, physical activity, bending over and in a horizontal position.

Diagnosis of GERD is based on characteristic complaints. The main method of instrumental diagnosis of GERD is FGS. If necessary, X-ray examination with contrast is performed.

Treatment of GERD must be prescribed by a doctor.

This usually includes diet and proton pump inhibitors (omeprazole, pariet). The main treatment should be carried out within 4-8 weeks, maintenance therapy – 6-12 months. In this case, the probability of relapse (return of the disease) is up to 80% with erosive esophagitis and up to 98% with improperly prescribed treatment.

In addition, it is necessary: ​​

• Reduce body weight (if it is increased), stop smoking;
• Diet: Avoid tomatoes in any form, acidic fruit juices, gas-producing foods, fats, chocolate, coffee, garlic, onions, peppers, alcohol, very spicy, hot or cold foods, and carbonated drinks;
• Overeating should be avoided; they should stop eating two hours before bedtime. You should not increase the number of meals: it is necessary to observe 3-4 meals a day without snacks;
• Conditions that increase intra-abdominal pressure should be prevented (exclusion of loads that increase intra-abdominal pressure, wearing corsets, bandages and tight belts, lifting weights of more than 8-10 kg on both hands, work associated with forward bending of the torso, physical exercises associated with overstrain of the abdominal muscles)

In some cases, an operation is prescribed.

Surgery is necessary if:

• Therapy fails for 3 months or more (reflux persists or pain or heartburn persists)
• Presence of heart attacks (angina pectoris, arrhythmias) caused by GERD
• Organic damage to the esophagus (scarring, stenosis)
• Barrett’s esophagus according to FGS

CAUTION. Barrett’s esophagus is one possible complication of GERD. Barrett’s esophagus is 125 times more likely to develop esophageal cancer than the general population!!! Esophageal cancer is very aggressive and responsive to therapy.

Laparoscopic fundoplication is the gold standard for GERD surgery worldwide.

In this operation, the fundus of the stomach is wrapped around the esophagus and sutured. The created cuff prevents the reflux of gastric contents into the esophagus.

We have been performing fundoplication since 2001. During this time, more than 300 operations have been performed. In 15 years, we have never needed to switch to open surgery. The presence of previous operations is not a contraindication to surgery.

The operation is very well tolerated by the patient. After our operations, the patient stays in the hospital for 1 day (on average). Most patients are discharged the next day. Pain is minimal.

We perform the operation with a laparoscopic (endovideosurgical) approach. With this technique, there is no large incision. 5 punctures of the anterior abdominal wall are performed (5 and 10 mm each). An inert gas is pumped inside, a video camera and instruments are introduced. The operation is carried out from the inside.

After the operation, you must follow a diet and limit physical activity for a month. A month later, the restrictions are lifted.

To make an appointment for a consultation: e-mail: [email protected], tel.: +7 (391) 297-52-52

5

In the 1980s and 1990s, the number of patients requiring surgical treatment significantly decreased. This was due to the emergence of new antisecretory, antacid and prokinetic drugs. Over the past decade, the developed drug treatment regimens have significantly reduced the risk of complications and improved the quality of life of patients with mild to moderate reflux esophagitis. However, the main problem of conservative treatment was and remains an almost complete relapse of the disease after the termination of the next course of drug therapy. The untimely performance of the operation for reflux esophagitis and HH is largely due to the fact that surgeons and gastroenterologists still do not have a unified point of view on the tactics of treating patients with these pathological conditions. Disputes continue about the indications for its surgical treatment and the timeliness of the transition from conservative to surgical treatment. Particularly controversial are the issues of choosing treatment tactics for mild and moderate reflux esophagitis.

It is undesirable to take drugs that reduce the tone of the LES (theophylline, progesterone, antidepressants, nitrates, prostaglandins, calcium antagonists, β-blockers, anticholinergic drugs), as well as having an adverse effect on the mucosa of the esophagus (non-steroidal anti-inflammatory drugs, doxycycline, quinidine).

Drug treatment should be aimed at reducing the acidity of gastric juice, neutralizing the produced hydrochloric acid and accelerating the evacuation of food from the stomach. To this end, therapy may include the use of various groups of drugs.

Antacids (almagel, maalox, phosphalugel, gastal, etc.) and alginates (gaviscon, topalkan, etc.) are superior to other drugs in terms of the speed of achieving a therapeutic effect (pain and heartburn relief). Antacids are prescribed for symptomatic purposes, their action is aimed at neutralizing the acid and, unfortunately, for a short time. Their main active ingredients are aluminum hydroxide, magnesium trisilicate, bismuth nitrate. Some of the above complex antacids are available in tablets, others – in the form of a gel. The frequency of their intake is determined by the severity of clinical symptoms, usually 4-5 times a day between meals and at bedtime. The advantage of these drugs is good tolerability by most patients and the rapid onset of the clinical effect.

There are, however, adverse effects of taking antacid preparations. In particular, aluminum-containing drugs with prolonged use can cause hypophosphatemia and constipation. After a series of chemical transformations, these preparations form poorly soluble compounds excreted with feces in the human intestine, which include phosphorus. This can be avoided by the appointment of phosphorus-containing agents (for example, phosphalugel, but its alkalizing ability is less than that of almagel).

Massive therapy with calcium carbonate leads to alkalosis and is contraindicated in hypercalcemia, osteochondrosis, the presence of calcium-containing stones in the kidneys and gallbladder.

Taking into account the important role of esophageal and gastric motility disorders in the pathogenesis of EC, prokinetics – drugs that normalize the motility of the gastrointestinal tract, improve the function of the lower esophageal sphincter, occupy a significant place in the treatment of such patients. Prokinetics increase LES pressure, improve esophageal clearance and gastric emptying.

H ₂ histamine receptor blockers. The emergence of this group of drugs has opened an era of effective drug therapy to reduce the secretion of hydrochloric acid. Appeared in the 1970s, they played a big role in the treatment of gastric and duodenal ulcers. However, these drugs were less effective in treating reflux esophagitis. Currently, there are 5 generations of H ₂ -blockers: I generation – cimetidine; II – generation – ranitidine; III generation – famotidine; IV generation – nizatidine; V generation – roxatidine. Currently, drugs from the group of ranitidine (zantac, ranitin) and famotidine (quamatel, famosan, gastromsidine) are most widely used, which are prescribed mainly for catarrhal forms of EC. These drugs effectively reduce the basal secretion of hydrochloric acid in the stomach and inhibit the secretion of pepsins. In the treatment of patients with erosive forms of the disease, they often turn out to be insufficiently effective even when taking double doses (600 mg of ranitidine and 80 mg of famotidine per day) and therefore gave way to their place inhibitors H ⁺ , K ⁺ py) , which is currently the most powerful antisecretory drugs.

Proton pump inhibitors (omeprazole, lansoprazole and pantoprazole) were introduced into clinical practice in the late 1980s [7]; rabeprazole and esomeprazole appeared not so long ago. Usually also given in double doses (omeprazole 40 mg, lansoprazole 60 mg, pantoprazole 80 mg), they achieve healing of esophageal erosions in 85-90% of patients, including those resistant to H ₂ -blockers. The drugs of this group are practically devoid of side effects since they exist in the active form only in the parietal cell.

At the same time, recent studies have shown that when using the usually recommended therapeutic dose of omeprazole (20 mg 2 times a day), approximately 20% of patients with EC retain pronounced changes in intraesophageal pH, and in almost 1/3 of patients, doses of omeprazole significantly exceeding standard therapeutic doses (up to 140 mg per day) are required to obtain a therapeutic effect.

The main course of treatment of EC exacerbations (especially erosive and ulcerative forms of EC) requires at least 8-12 weeks. At the same time, discontinuation of medication after achieving healing of esophageal erosions in many patients leads to a rapid recurrence of the disease. Therefore, many patients require maintenance treatment with proton pump blockers or prokinetics (in half daily doses) for at least 1 year, which allows maintaining disease remission in most patients.

Complications of taking antisecretory drugs .

According to recent publications, the number of patients with partial or complete non-response to the standard dose of PPI (once a day for 8 weeks) is 40-50%.

The “ rebound syndrome ” described in the literature leads to a sharp increase in gastric secretion after the withdrawal of antisecretory therapy due to hypergastrinemia. The development of the “rebound” syndrome was noted already after 2-4 weeks of taking h3-blockers and 6-8 weeks of taking PPIs . Of course, a sharp increase in acid secretion can provoke an acute ulcer, but this probability is higher with the use of H ₂ -blockers.

The existing “ fatigue syndrome” of receptors is clinically significant and characteristic of all drugs of the h3-histamine receptor blocker group. It is known that after 5-7 days of continuous use of H2-blockers, the effectiveness of therapeutic doses is reduced by more than 50%, and with longer use, the antisecretory effect is completely lost.

The literature describes the phenomenon of “nocturnal acid breakthrough” – a decrease in pH in the stomach below 4.0 for several hours in the period from 22 to 6 hours while taking PPIs. The development of this phenomenon was found in almost 70% of patients with reflux esophagitis and 80% of patients with Barrett’s esophagus, and is probably associated with an increase in the activity of the vagus nerves at this time and a decrease in the production of mucus by additional cells. licobacter pylori, which is described in more detail in the corresponding chapter.

Many authors confirm a 2-3-fold increase in the risk of developing diarrhea caused by Clostridium difficile against the background of long-term PPI therapy.

The relationship between long-term PPI use and fractures is still debatable. The review by L. Laine compared the data of 13,556 patients with hip fractures older than 50 years and 135,386 persons who made up the control group matched by sex and age for PPIs. An increased risk of hip fracture has been shown with PPI use for more than a year, with the highest risk seen with long-term high (>1.75) daily PPI use.

Patients with gastroesophageal reflux who take antisecretory drugs for a long time are at risk of developing pneumonia

Conservative measures in patients with complications of reflux esophagitis are often at the same time preoperative preparation. Bougienage in patients with peptic stricture of the esophagus should be carried out under the cover of a massive antiulcer patient. Since the exacerbation of chronic esophagitis occurs against the background of mechanical damage and irritation, and the expansion of the stricture facilitates gastroesophageal reflux, immediate antireflux intervention is necessary soon after the completion of the course of bougienage.