El omeprazol es un fármaco con acción antiácida. Bloquea la producción de ácido del estómago. Es un medicamento muy útil y beneficioso pero no por ello hay que darlo a quien no lo necesita.
En qué situaciones es beneficioso:
- Tratamiento de la úlcera duodenal y de la úlcera
gástrica benigna, incluyendo las que
complican los tratamientos con los fármacos
antiinflamatorios no esteroideos
(AINEs).
- Tratamiento profiláctico de la úlcera duodenal,
úlcera gástrica benigna y/o erosiones
gastroduodenales inducidas por fármacos
antiinflamatorios no esteroideos (AINEs)
en pacientes de riesgo (ancianos y/o en antecedentes
de erosiones gastroduodenales)
que requieran un tratamiento continuado con AINEs.
- Reflujo gastroesofágico. El omeprazol está indicado
en el tratamiento de la esofagitis
por reflujo, de síntomas severos de enfermedad por
reflujo no inflamatoria y de
síntomas leves que no respondan al tratamiento
convencional.
- Síndrome de Zollinger-Ellison.
- Tratamiento de la úlcera gástrica y duodenal
asociadas a Helicobacter pylori tanto en
terapia dual (tratamiento combinado con amoxicilina o
claritromicina) como en una
terapia triple (tratamiento combinado con dos agentes
antimicrobianos a la vez) cuya
tasa de erradicación es notablemente más elevada con
una duración menor del
tratamiento.
En que situaciones no es beneficioso:
- Si no tiene úlcera gástrica ni duodenal, ni reflujo gastroesofágico ni síndrome de Zollinger-Ellison
- Si toma antiinflamatorios no esteroideos (AINEs) pero no es usted anciano o no tiene antecedentes de erosiones gastroduodenales.
- Si toma otros fármacos el omeprazol no le protegerá de problemas digestivos derivados de estos.
¿Qué problemas puede dar si se usa de forma continuada? Una publicación reciente demuestra que el omeprazol tomado más de dos años se asocia con una disminución de la absorción de la vitamina B12 presente en las carnes. Si el estómago no tiene ácido no se digerirán bien y en consecuencia nos quedamos sin vitamina B12. Las personas ancianas que desarrollen un deficit de vitamina B12 pueden ver mermadas o alteradas sus capacidades mentales. Esto es reversible aportando la vitamina.
El omeprazol tiene otros problemas si se usa mucho tiempo (hipomagnesemia, aumento del riesgo de fracturas, hipoparatiroidismo...). Viene bien recordar que ningún medicamento es inocuo.
Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12 Deficiency
JAMA. 2013;310(22):2435-2442. doi:10.1001/jama.2013.280490.
Importance
Proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) suppress the production of gastric acid and thus may lead to malabsorption of vitamin B12. However, few data exist regarding the associations between long-term exposure to these medications and vitamin B12 deficiency in large population-based studies.
Objective To study the association between use of PPIs and H2RAs and vitamin B12 deficiency in a community-based setting in the United States.
Design, Setting, and Patients We evaluated the association between vitamin B12 deficiency and prior use of acid-suppressing medication using a case-control study within the Kaiser Permanente Northern California population. We compared 25 956 patients having incident diagnoses of vitamin B12 deficiency between January 1997 and June 2011 with 184 199 patients without B12 deficiency. Exposures and outcomes were ascertained via electronic pharmacy, laboratory, and diagnostic databases.
Main Outcomes and Measures Risk of vitamin B12 deficiency was estimated using odds ratios (ORs) from conditional logistic regression.
Results Among patients with incident diagnoses of vitamin B12 deficiency, 3120 (12.0%) were dispensed a 2 or more years’ supply of PPIs, 1087 (4.2%) were dispensed a 2 or more years’ supply of H2RAs (without any PPI use), and 21 749 (83.8%) had not received prescriptions for either PPIs or H2RAs. Among patients without vitamin B12 deficiency, 13 210 (7.2%) were dispensed a 2 or more years’ supply of PPIs, 5897 (3.2%) were dispensed a 2 or more years’ supply of H2RAs (without any PPI use), and 165 092 (89.6%) had not received prescriptions for either PPIs or H2RAs. Both a 2 or more years’ supply of PPIs (OR, 1.65 [95% CI, 1.58-1.73]) and a 2 or more years’ supply of H2RAs (OR, 1.25 [95% CI, 1.17-1.34]) were associated with an increased risk for vitamin B12 deficiency. Doses more than 1.5 PPI pills/d were more strongly associated with vitamin B12 deficiency (OR, 1.95 [95% CI, 1.77-2.15]) than were doses less than 0.75 pills/d (OR, 1.63 [95% CI, 1.48-1.78]; P = .007 for interaction).
Conclusions and Relevance Previous and current gastric acid inhibitor use was significantly associated with the presence of vitamin B12 deficiency. These findings should be considered when balancing the risks and benefits of using these medications.
Conclusiones y Relevancia. El uso, previo o actual, de inhibidores de la secreción ácida gástrica fue significativamente asociado con el hallazgo de déficit de vitamina B12. Estos hallazgos han de considerarse cuando se valore el nivel de riesgo y beneficio al indicar esta medicación.
Objective To study the association between use of PPIs and H2RAs and vitamin B12 deficiency in a community-based setting in the United States.
Design, Setting, and Patients We evaluated the association between vitamin B12 deficiency and prior use of acid-suppressing medication using a case-control study within the Kaiser Permanente Northern California population. We compared 25 956 patients having incident diagnoses of vitamin B12 deficiency between January 1997 and June 2011 with 184 199 patients without B12 deficiency. Exposures and outcomes were ascertained via electronic pharmacy, laboratory, and diagnostic databases.
Main Outcomes and Measures Risk of vitamin B12 deficiency was estimated using odds ratios (ORs) from conditional logistic regression.
Results Among patients with incident diagnoses of vitamin B12 deficiency, 3120 (12.0%) were dispensed a 2 or more years’ supply of PPIs, 1087 (4.2%) were dispensed a 2 or more years’ supply of H2RAs (without any PPI use), and 21 749 (83.8%) had not received prescriptions for either PPIs or H2RAs. Among patients without vitamin B12 deficiency, 13 210 (7.2%) were dispensed a 2 or more years’ supply of PPIs, 5897 (3.2%) were dispensed a 2 or more years’ supply of H2RAs (without any PPI use), and 165 092 (89.6%) had not received prescriptions for either PPIs or H2RAs. Both a 2 or more years’ supply of PPIs (OR, 1.65 [95% CI, 1.58-1.73]) and a 2 or more years’ supply of H2RAs (OR, 1.25 [95% CI, 1.17-1.34]) were associated with an increased risk for vitamin B12 deficiency. Doses more than 1.5 PPI pills/d were more strongly associated with vitamin B12 deficiency (OR, 1.95 [95% CI, 1.77-2.15]) than were doses less than 0.75 pills/d (OR, 1.63 [95% CI, 1.48-1.78]; P = .007 for interaction).
Conclusions and Relevance Previous and current gastric acid inhibitor use was significantly associated with the presence of vitamin B12 deficiency. These findings should be considered when balancing the risks and benefits of using these medications.
Conclusiones y Relevancia. El uso, previo o actual, de inhibidores de la secreción ácida gástrica fue significativamente asociado con el hallazgo de déficit de vitamina B12. Estos hallazgos han de considerarse cuando se valore el nivel de riesgo y beneficio al indicar esta medicación.
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