The most effective drugs for the treatment of reflux esophagitis. Conservative treatment of reflux esophagitis Omeprazole and Pantoprazole - which is better

glycerol;
dye charming red AC;
gelatin;
methylparaben;
food additive E 171;
propylparaben;
sodium lauryl sulfate;
purified water.

The active ingredient is omeprazole.

The composition of one capsule includes 20 mg of pellets in terms of omeprazole. Pellets are spherical microgranules. Auxiliary components of pellets: additives E421, E217, E171, E219, E170; dodecyl sulfate and sodium hydrogen phosphate, dodecahydrate, cetyl alcohol, sucrose, hypromelose.

The composition of the lyophilizate includes 40 mg of omeprazole, as well as sodium hydroxide and disodium edetate.

Capsules to / r 0.02 g (packaging No. 10, No. 30, No. 60, No. 100 and No. 120).

Lyophilizate for the preparation of solution for intravenous administration and infusion therapy (40 mg vials).

pharmachologic effect

When the drug "Omeprazole" penetrates into the acidic environment of the stomach and deep into the cells that are responsible for the production of digestive juice and enzyme, it begins to regulate these processes. The drug reduces the production of gastric juice and its level of activity, has a detrimental effect on the Helicobacter bacteria, which are observed in reflux esophagitis.

"Omeprazole" in capsules incorporates coated microgranules, which, after dissolution, begin to act 60 minutes after taking the medicine and can reach two hours. The duration of action reaches 24 hours.

Antiulcer, inhibitory proton pump.

Pharmacological group: proton inhibitor.

Indications for use

A broad-spectrum drug for the treatment of a number of gastrointestinal diseases.

ulcerative lesions of the stomach caused by Helicobather infection;
Zolliger-Ellison syndrome;
duodenal ulcer;
gastroesophageal reflux;
severe heartburn, the duration of which reaches two days;
gastritis resulting from the use of nonsteroidal drugs that relieve inflammation;
erosive esophagitis;
hypersecretory disorders of the digestive system;
polyendocrine adenomatosis;
recurrence of chronic duodenal ulcer;
recurrence of stress and drug ulcers.

Restrictions on treatment apply to children, nursing and in case of illness of other organs.

if the age of the patient has not reached five years;
with existing hypersensitivity to the components of the drug;
if a woman is breastfeeding;
with liver and kidney failure.

For pregnant women, the drug is prescribed with caution and under the supervision of a physician.

Indications for the use of Omeprazole Akri are no different from the indications that are listed in the annotation of Omeprazole produced by another pharmaceutical company (Sandoz, Gedeon Richter Plc., STADA CIS, etc.). The medicine is effective for:

benign stomach / duodenal ulcers(including if the disease is associated with taking NSAIDs);
eradication therapy for H. pylori (in combination with antibacterial drugs);
GERD;
prevention of aspiration of acidic gastric contents;
ulcerogenic adenoma of the pancreas;
relief of symptoms of acid-dependent dyspeptic disorders(the drug helps with heartburn eliminates heaviness in the abdomen, belching, flatulence, bloating, bad taste and nausea).

What does Omeprazole (Acri, Stada, Sandoz, Richter, etc.) help with these diseases? The drug, acting at the molecular level, inhibits the synthesis of hydrochloric acid by the parietal cells of the gastric mucosa and prevents increased secretion after eating.

Thus, in the treatment with Omeprazole, there is a rapid regression of diseases of the stomach and / or 12-colon caused by a violation of the acidity, the symptoms of dyspepsia and pain disappear, and overall well-being improves.

By provoking a persistent decrease in acidity, the drug creates optimal conditions for the successful eradication of H. pylori, which is the cause of 90% of all gastritis and peptic ulcer disease.

With gastritis, omeprazole is prescribed only in cases where the patient has increased acidity of the gastric secretion.

With hypo- and normoacid gastritis, the use of the drug is contraindicated, since it can provoke thinning of the mucous membrane, a decrease in the number of glands and secretory insufficiency of the stomach with zero acidity of the digestive juice contained in it.

The optimal dose for gastritis is 20 mg / day. Treatment usually lasts 2 to 3 weeks. If the disease is associated with H. pylori infection, the patient is prescribed antibacterial drugs simultaneously with Omeprazole according to one of the generally accepted schemes for such cases.

Low-dose proton pump inhibitors (PPIs) (for example, Omeprazole Sandoz capsules containing 10 mg of the active ingredient) are OTC drugs and can be used to treat occasional heartburn.

A doctor's consultation is necessary if:

the patient has other symptoms (weight loss, pain in the epigastrium or behind the sternum, dysphagia);
relapses heartburn become more frequent.

The oldest and most well-known way to relieve heartburn is the use of Al / MgCa containing antacids, the mechanism of action of which is the ability to neutralize hydrochloric acid in the lumen of the stomach.

Their only advantage is speed. The disadvantages are the short-term effect (no more than 1.5 hours), the ability to provoke stool disorders (depending on the composition of the drug, the patient may experience constipation or diarrhea), side effects associated with the absorption of the ions contained in their composition.

In addition, antacids interact quite aggressively with other drugs, while disrupting the absorption of simultaneously taken drugs. With heartburn, which is a manifestation of GERD, the effectiveness of antacids is very low.

Another group of drugs that have traditionally been used to treat heartburn are alginates. They do not have a neutralizing effect, but create a mechanical barrier that prevents the contents of the stomach from entering the esophagus.

Despite all the advantages of alginates and antacids, the most effective for heartburn are drugs that inhibit the formation of hydrochloric acid. Prior to the introduction of PPIs, the most popular drugs were H2-histamine receptor blockers.

Their effect occurs later than the effect of alginates or antacids (this is due to the need for these drugs to enter the systemic circulation), but it persists for 8-12 hours.

The disadvantage of H2-histamine receptor blockers is that for the relief of persistent, recurrent heartburn, their use in OTC doses does not always give the desired effect.

Also, when taking H2-histamine blockers in small doses, a phenomenon known as “escape effect” may form, which may be associated with the development of tolerance to these drugs.

In addition, they - especially first-generation drugs - have a pronounced inhibitory effect on the system of microsomal oxidation of the liver and can interact with concomitantly taken drugs (while changing their pharmacokinetic parameters).

H2-histamine blockers potentiate the effect of alcohol, which makes them ineffective for relieving heartburn caused by alcohol.

Currently, the most effective treatment for heartburn (including heartburn that occurs at night) is considered to be the use of over-the-counter PPIs, which contain 10 mg of omeprazole.

The full therapeutic effect of the drug for heartburn is achieved already in the first 4 days, although in some patients the disappearance of symptoms and complete relief is noted already on the first day of using Omeprazole.

The use of small doses of the drug "on demand" for the treatment of non-erosive reflux esophagitis in more than half of patients helps to eliminate dyspeptic symptoms for at least six months.

Omeprazole is well tolerated by patients and has a low risk of developing serious side effects in patients taking it. When taking low doses of the drug, adverse events are usually single and are characterized by a moderate degree of severity.

Side effects, which are described in the Vidal and Wikipedia reference books with long-term use of high doses of PPIs, do not occur when taking low doses of omeprazole.

In chronic pancreatitis, the effectiveness of omeprazole is due to its ability to reduce intrapancreatic pressure by suppressing secretion and thereby reduce the load on the inflamed and weakened pancreas (PZhZh).

Thus, the purpose of prescribing the drug for pancreatitis is to ensure maximum rest of the pancreas.

In addition, chronic pancreatitis in most cases is complicated by GERD, the main causes of which are dysmotility of the esophagus and stomach, weakness of the esophageal sphincters, as well as hiatal hernia in combination with increased secretion of acid in the stomach.

Once in the esophagus, the acidic contents of the stomach provoke heartburn, chest pain, sour taste, reflex cough and increased incidence of dental caries.

Omeprazole helps with heartburn and eliminates other dyspeptic symptoms, significantly alleviating the course of GERD, reducing the intensity of its manifestations and unloading the pancreas. The drug can be used for a long time (from one month to six months or more).

IV use of the drug is indicated as an alternative to taking capsules in the following cases:

duodenal ulcers;
treatment and prevention of recurrence stomach ulcers;
H. pylori eradication at peptic ulcer(in combination with appropriate antibacterial agents);
treatment and prevention peptic ulcer associated with the use of NSAIDs (including in patients at risk);
reflux esophagitis therapy(including long-term treatment of patients with an inactive form of the disease);
treatment of symptomatic GERD;
treatment ulcerogenic adenoma of the pancreas.

Contraindications to the use of the drug are age up to 5 years (with a child weighing up to 20 kg), lactation and hypersensitivity to omeprazole or excipients contained in capsules / lyophilisate.

How does omeprazole help with esophagitis?

Pharmacodynamics and pharmacokinetics

Omeprazole inhibits the proton pump (H / K -ATPase) in the parietal (lining) cells of the stomach, thereby blocking the final stage of the formation of hydrochloric (hydrochloric) acid.

The drug begins to act within the first 60 minutes after administration. The effect persists for the next 24 hours, while it reaches a peak 2 hours after ingestion.

With a duodenal ulcer, taking 0.02 g of the drug allows maintaining intragastric acidity at level 3 for 17 hours. 3-5 days are enough to fully restore secretory activity.

The substance is rapidly absorbed from the alimentary canal. TSmax varies from 30 to 60 minutes, bioavailability - from 30 to 40%. The drug is approximately 90% bound to plasma proteins and is almost completely metabolized in the liver.

T1 / 2 - from 30 minutes to 1 hour. Metabolic products are excreted mainly by the kidneys. With chronic renal failure, excretion decreases in proportion to the decrease in Clcr. In the elderly, excretion decreases while bioavailability increases. With liver failure, T1 / 2 is 3 hours with 100% bioavailability.

Overdose

Symptoms of an overdose of Omeprazole: confusion, drowsiness, decreased clarity in the perception of visual images, headache, dryness of the oral mucosa, nausea, arrhythmia, tachycardia.

Therapy: symptomatic. Hemodialysis is considered insufficiently effective.

To achieve an effective result in the treatment of reflux esophagitis with the drug "Omeprazole", you should follow the attached instructions. Manufacturers of the medicine indicate that it is enough to take it once a day, preferably in the morning and regardless of the meal.

Often, "Omeprazole" is taken at 0.2 g per day.

The drug, produced in capsules, should be swallowed whole, without chewing, and washed down with a few sips of water. When treating esophagitis, the doctor prescribes 20 mg of medication once every 24 hours. With a severe course of the disease, it is allowed to increase the dosage to forty milligrams. The duration of treatment can last from four to eight weeks. If the doctor ascribes "Omeprazole" in the complex, then esophagitis therapy with this medicine lasts 60 days.

If you do not follow the doctor's recommendations and do not follow the instructions for the drug, then an overdose may occur, which is manifested by arrhythmia, drowsiness, nausea, tachycardia and headache. The patient may notice dry mouth and blurred vision.

Side effects

Side effects of the drug appear as:

disorders of the function of the digestive system (abdominal pain, stool disorders, nausea, vomiting, increased activity of liver enzymes, flatulence, taste disturbance, stomatitis, dry mouth, liver dysfunction, patients with previous severe liver disease may develop hepatitis).
Impaired function of the hematopoietic organs, the symptoms of which are leuco-, pancyto-, thrombocytopenia,agranulocytosis.
Functional disorders of the musculoskeletal system ( myalgia, arthralgia, myasthenia gravis).
Skin disorders ( photosensitivity, skin rashes, skin itching, alopecia, erythema multiforme exudative).
Dysfunction of the NS: in patients with concomitant severe somatic pathologies, dizziness, headaches, depression or agitation are possible; in patients with previous severe liver disease - encephalopathy.
Hypersensitivity reactions: bronchospasm, fever,angioedema, hives, anaphylactic shock, interstitial nephritis.
Other violations: gynecomastia, general malaise, peripheral edema, visual impairment, hyperhidrosis, the formation of benign glandular (glandular) cysts in the stomach (pathology develops with prolonged use of the drug as a result of suppression of HCl secretion and is reversible).

In some cases, the following side effects may occur during the treatment of esophagitis with Omeprazole:

diarrhea;
gagging;
constipation;
nausea;
hives;
painful gas formation;
pain in the abdomen;
pain in muscles and joints;
violations of taste buds;
depression;
feeling of dryness in the oral cavity;
malfunction of the liver;

excessive sweating;
dizziness;
blurred vision;
myalgia;
fever;
hepatitis;
stomatitis;
arthralgia;
headache;
thrombocytopenia;
itching of the skin;
peripheral edema;
leukopenia;
skin rash;
alopecia;
anaphylactic shock;
general malaise;
gynecomastia.

Application in childhood

It is not allowed to take the drug "Omeprazole" to children whose age has not reached the age of five. However, at the discretion of the physician, the drug may be given to young children with acute ailments of the upper digestive tract. Treatment in children with this medication should be carried out exclusively under the guidance of a doctor.

Children's dosage is calculated taking into account the body weight of the baby. If the weight is up to ten kilograms, then the medicine is prescribed five milligrams once a day. If the body weight is 10-20 kg, then the dosage is doubled and is 10 mg. A child weighing more than 20 kg is prescribed the drug in a volume of 20 mg for 24 hours.

Omeprazole powder and tablets: instructions for use

The daily dose of the drug depends on the indications:

peptic ulcer, esophageal reflux- 20 mg;
reflux esophagitis- 20, in severe cases of the disease - 40 mg;
relapse prevention reflux esophagitis and peptic ulcer- 10 mg (in small doses, the drug can be taken for a long time);
prevention acid aspiration pneumonitis- 40 mg once an hour before surgery (if the operation lasts more than 2 hours, the patient is shown to re-administer the required dose);
acid-dependent dyspepsia- 10-20 mg;
ulcerogenic adenoma of the pancreas- 20-120 mg (if the dose exceeds 80 mg / day, it should be divided into 2-3 doses).

Resistant to other antiulcer drugs, patients are shown taking omeprazole at a dose of 40 mg / day.

For the eradication of H. pylori, one of the approved international treatment regimens is used, according to each of which Omeprazole should be taken 2 times a day. 20 mg in addition to the main therapy.

With a duodenal ulcer, therapy can be “double” or “triple”.

"Triple" therapy is carried out as follows:

first week - Amoxicillin Clarithromycin(twice a day, 1 and 0.5 g, respectively);
second week - Clarithromycin Metronidazole(twice a day, 0.25 and 0.4 g, respectively; instead of Metronidazole you can take 0.5 mg Tinidazole);
third week - Amoxicillin Metronidazole(three times a day, 0.5 and 0.4 g, respectively).

"Double" therapy: 0.75 g of Amoxicillin 2 r./day. within 14 days 0.5 g Clarithromycin 3 r./day. within 14 days.

“Double” therapy for stomach ulcers: 0.75-1 g of Amoxicillin 2 r./day. within 14 days.

For the eradication of H. pylori, Clarithromycin, Trichopolum, Omeprazole and De-Nol can also be used. Clarithromycin and Trichopol are prescribed at a dose of 15 mg / kg / day, Omeprazole - at a dose of 0.02 g 1 r. / Day, De-Nol should be taken 4 r. / Day. 1 tablet. The duration of such therapy is 10 days.

Omeprazole capsules are prescribed for children from the age of 5 (with a weight of at least 20 kg).

Instructions for use of Omeprazole-Richter and other generics of the drug are similar to the instructions for Omeprazole-Acre.

Capsules are taken orally with a small amount of liquid (possible with food), without crushing, chewing, without damaging the integrity of the shell. The preferred time of admission is in the morning (before meals).

The duration of the course with a duodenal ulcer, depending on the characteristics of the clinical picture and the response of the patient's body to treatment, is from 2 to 5 weeks, with reflux esophagitis and stomach ulcers - from 4 to 8 weeks.

With acid-dependent dyspepsia, the course lasts 2-4 weeks. If, upon completion, the symptoms do not disappear or quickly reappear, the patient's diagnosis should be reassessed. If necessary, the drug is continued to be taken in a smaller single dose.

In the presence of indications, omeprazole can be used for a long time (until erosion and ulcerative defects of the gastric mucosa / 12-colon intestine heal). With ulcerogenic adenoma of the pancreas, the course of treatment can stretch up to 5 years.

OTC preparations of omeprazole (with a dosage of the active substance 10 mg) are not recommended to be taken for longer than 14 days without the approval of the attending physician.

Intravenous administration of the drug is an alternative to oral therapy in cases where capsules are not possible.

The standard dose is 40 mg 1 r./day. intravenously. Treatment of patients with ulcerogenic adenoma of the pancreas begins with a dose of 60 mg / day. If there is a need to use higher doses, the treatment regimen is selected individually. If the daily dose exceeds 60 mg, it must be divided into 2 injections.

Intravenously, the drug is administered as an infusion lasting from 20 minutes to half an hour.

Before administration, the contents of the vial are dissolved in a volume of 5 ml, and then the volume is immediately adjusted to 100 ml. As a solvent, a 5% glucose solution or a 0.9% NaCl solution is used. The stability of the drug depends on the pH of the solvent, so do not use for dilution:

other solutions;
more solvent.

The infusion solution should be used immediately after preparation. Any residue or waste must be disposed of.

Interaction with other drugs

In the process of treating diseases of the gastrointestinal tract with "omeprazole" and other drugs, one should take into account its ability to reduce the absorption of iron salts, ketoconazole and ampicillin esters, and increase the concentration of clarithromycin in the blood plasma. When used in parallel with other drugs, it can enhance the effect of the inhibitor in the circulatory system and in other medicines.

Long-term use of the drug at a dose of 0.02 g 1 p./day. in combination with Theophylline, Naproxen, caffeine, Piroxicam, Metoprolol, Diclofenac, ethanol, Propranolol, Cyclosporine, Quinidine, Lidocaine and Estradiolne leads to a change in their plasma concentration.

With simultaneous use with antacids, no interaction was noted.

Omeprazole affects the bioavailability of any drug, the absorption of which depends on the value of the acidity index (iron salts, for example).

special instructions

Due to the likelihood of side effects from the NS, Omeprazole should be used with caution by drivers of vehicles and persons who work with potentially dangerous mechanisms.

Before proceeding with the treatment of esophagitis with the drug "Omeprazole", malignant tumors should be excluded from the patient, since during the course of therapy signs of cancer can be hidden, which will delay the correct diagnosis and the main antitumor treatment. In addition, the patient should not have such infections in the gastrointestinal tract as salmonella, compylobacter and others like it, since the medicine can only exaggerate their reproduction. The doctor must rule out liver and kidney failure.

Many patients compare two drugs with a similar name "Omeprazole" and "Omez" and want to find out which one is better and more effective. Thus, "Omeprazole" is a cheap analogue of "Omez" with the active ingredient omeprazole. The composition of "Omeprazole" uses cheaper substances, which causes its slow speed in reaching the maximum concentration in the blood.

Omez, like Omeprazole, quickly enters the mucous layer of the stomach and is absorbed from the gastrointestinal tract into the blood. Omez reaches its maximum effect within 60 minutes after taking the capsules.

"Omeprazole" has an analogue with a similar name - "Omez".

A distinctive feature of "Omez" from the analogue drug is the country of origin. Omeprazole is produced in Russia, when Omez comes from India, this affects the price of medicines to a greater extent. "Omez" was released earlier than its analogue, so it is an original medicine. The doctor prescribes "Omez" or its generic, based on the severity of the course of the disease, since the original drug uses more effective substances, then "Omez" has more advantages over "Omeprazole".

With inflammation of the mucous membrane of the esophagus, along with the regimen and diet, drug treatment of esophagitis is used. The choice of medicine for esophagitis depends on the type of disease and the nature of the course of the disease. With catarrhal, erosive and pseudomembranous esophagitis, antacid drugs are prescribed. Drugs to normalize the motility of the stomach and intestines, reducing the level of hydrochloric acid are prescribed in the treatment of this disease. With the development of an abscess and phlegmon of the esophagus, as well as an acute form of the disease, antibiotic therapy is prescribed, which combines large doses of antibiotics with a wide spectrum of action.

Drugs for esophagitis

Modern pharmacology offers a huge number of drugs used for esophagitis, but they differ in effectiveness, method of application. The success of drug treatment primarily depends on the correct determination of the necessary drugs and the scheme for their use. To avoid undesirable consequences, it is necessary to carefully read the instructions, paying special attention to the interaction with other drugs and the conditions of admission for pregnant women.

Prokinetics, antacids and alginates are used to eliminate the clinical manifestations of this disease, as they are symptomatic drugs. There are other drugs, such as Lanzoptol, which reduce the acidity of gastric juice, protecting the esophageal mucosa from irritation. H2 receptor blockers are highly effective in eliminating inflammatory processes and reducing the severity of symptoms. Drugs for the treatment of esophagitis are available in different forms, but in general for esophagitis, tablets are the most common and convenient form.

Omeprazole for esophagitis

The action of Omeprazole begins after entering the acidic environment characteristic of the stomach. Penetrating deep into the cells responsible for the production of gastric juice and an enzyme that breaks down proteins, the drug has a regulatory effect on these processes. The most modern antisecretory drug suppresses the production of hydrochloric acid while reducing the level of its activity. The main culprit of reflux esophagitis is Helicobacter pylori, and Omeprazole has a bactericidal effect.

Produced in the form of transparent capsules, the drug is administered orally. However, if this is not possible, a drug treatment regimen for internal administration is used. The action of omeprazole manifests itself very quickly, literally an hour after administration and continues throughout the day. Restoration of the production of hydrochloric acid in full is noted five days after the completion of the course of drug treatment. Given that this medication has many side effects, in no case should you take Omeprazole without first consulting a doctor. If the cause of the disease is Helicobacter pylori microorganisms, then the tablets are taken according to a certain scheme.

Almagel with esophagitis

Among the drugs with antacid, astringent and enveloping action, Almagel for the treatment of esophagitis can be named among the first. Aluminum hydroxide, which is part of Almagel, under the influence of hydrochloric acid, turns into aluminum chloride, minimizing the harmful effects of the acid. Magnesium hydroxide, which is part of Almagel, in addition to neutralizing the acid, disavows the ability of aluminum chloride to provoke constipation. In addition, D-sorbitol, which is also part of the drug, enhances bile secretion and acts as a laxative. Uniform regulation of acidity does not cause flatulence and disturbance of water-electric balance. Eliminates the pain syndrome, which is part of it benzocaine.

De-Nol with esophagitis

In the treatment of chronic esophagitis caused by Helicobacter pylori, doctors call De-Nol one of the most effective drugs. Its advantages include:

By increasing the production of mucus and bicarbonates, the drug promotes the rapid formation of new tissues in damaged areas.

The main advantage of the properties of De-Nol is to prevent the production of substances that have a destructive effect on the mucous membrane.

De-Nol, when compared with other drugs, activates the movement of blood through the capillaries much more, increasing their blood supply.

The main active ingredient of the drug is bismuth tripotassium dicitrate, which has an astringent, antimicrobial and gastrocytoprotective effect, the ability of the tablets to dissolve well in the gastric mucus, increases the level of exposure to pathogens, directly in the shell itself. A certain risk of side effects is associated with prolonged use of the drug and the accumulation of bismuth.

Treatment of esophagitis with antibiotics

The need for antibiotics in esophagitis is caused by a purulent-inflammatory process, accompanied by severe pain. At the same time, with prolonged and mass antibiotic therapy, the development of candidal esophagitis is possible. In these cases, antifungal drugs are additionally prescribed.

Motilium with esophagitis

The properties of Motilium to increase the tone and motor activity of the smooth muscles of the stomach, combined with an increase in the tone of the lower esophageal sphincter and antiemetic action, makes it indispensable for eliminating the symptoms of esophagitis and the causes of the disease. It is strictly forbidden to use Motilium for internal bleeding, pituitary gland disease and for the treatment of children under five years of age.

Iberogast for esophagitis

The herbal medicinal product Iberogast has:

anti-inflammatory effect;

restores muscle tone, which ensures the normal movement of food;

restores mucosal health by inhibiting the growth of Helicobacter pylori, reducing acidity and improving the properties of gastric mucus.

Omeprazole for esophagitis

Release form and composition

A drug that is prescribed for gastrointestinal ailments, Omeprazole is available in tablets, capsules and powder for intravenous administration. Gelatin capsules are produced in packs of seven in a blister pack, there can be from one to four plates in a pack. You can find capsules in polymer jars, which fit 30-40 pieces. Powder for the preparation of the solution is available in a 40 mg vial and five vials per pack. You can buy the drug in pharmacies only with a doctor's prescription. Omeprazole contains the following auxiliary components:

glycerol;

dye charming red AC;

gelatin;

methylparaben;

food additive E 171;

propylparaben;

sodium lauryl sulfate;

purified water.

The active ingredient is omeprazole.

pharmachologic effect

Indications for use

The drug is used when it is necessary to treat the upper gastrointestinal tract, namely for the following diseases:

A broad-spectrum drug for the treatment of a number of gastrointestinal diseases.

ulcerative lesions of the stomach caused by Helicobather infection;

Zolliger-Ellison syndrome;

duodenal ulcer;

gastroesophageal reflux;

severe heartburn, the duration of which reaches two days;

gastritis resulting from the use of nonsteroidal drugs that relieve inflammation;

erosive esophagitis;

hypersecretory disorders of the digestive system;

polyendocrine adenomatosis;

recurrence of chronic duodenal ulcer;

recurrence of stress and drug ulcers.

How does omeprazole help with esophagitis?

For the treatment of reflux esophagitis, the drug "Omeprazole" is used, which has the following effect: it normalizes the level of acidity in the stomach. In addition, it regulates the work of cells responsible for the release of hydrochloric acid, and has a protective function on the cells and organs of the digestive system. Due to these properties, "Omeprazole" not only stops an attack of heartburn, but also acts as an excellent prophylactic agent for exacerbations of ailments of the gastrointestinal tract.

Methods of application and dosage

Often, "Omeprazole" is taken at 0.2 g per day.

The drug, produced in capsules, should be swallowed whole, without chewing, and washed down with a few sips of water. When treating esophagitis, the doctor prescribes 20 mg of medication once every 24 hours. With a severe course of the disease, it is allowed to increase the dosage to forty milligrams. The duration of treatment can last from four to eight weeks. If the doctor ascribes "Omeprazole" in the complex, then esophagitis therapy with this medicine lasts 60 days.

Results and effectiveness of treatment

When using the prescribed dosage, namely one capsule per day, the result of the drug is observed quickly. Reduction of pronounced symptoms occurs after an hour. The effectiveness of the drug is observed for four weeks or, in extreme cases, after two months, which is inherent in patients with a severe course of the disease.

During pregnancy and lactation

The medicine "Omeprazole", which is intended for the treatment of esophagitis, is not recommended for use by pregnant women and during breastfeeding.

Application in childhood

It is not allowed to take the drug "Omeprazole" to children whose age has not reached the age of five. However, at the discretion of the physician, the drug may be given to young children with acute ailments of the upper digestive tract. Treatment in children with this medication should be carried out exclusively under the guidance of a doctor. Children's dosage is calculated taking into account the body weight of the baby. If the weight is up to ten kilograms, then the medicine is prescribed five milligrams once a day. If body weight is 10-20 kg, then the dosage is doubled and is 10 mg. A child weighing more than 20 kg is prescribed the drug in a volume of 20 mg for 24 hours.

Contraindications

Like all medicines, "Omeprazole" has contraindications. Therefore, this medicine is not prescribed in the following case:

Restrictions on treatment apply to children, nursing and in case of illness of other organs.

if the age of the patient has not reached five years;

with existing hypersensitivity to the components of the drug;

if a woman is breastfeeding;

with liver and kidney failure.

For pregnant women, the drug is prescribed with caution and under the supervision of a physician.

Side effects

In some cases, the following side effects may occur during the treatment of esophagitis with Omeprazole:

diarrhea;

gagging;

constipation;

nausea;

hives;

painful gas formation;

pain in the abdomen;

pain in muscles and joints;

violations of taste buds;

depression;

feeling of dryness in the oral cavity;

malfunction of the liver;

excessive sweating;

dizziness;

blurred vision;

myalgia;

fever;

hepatitis;

stomatitis;

arthralgia;

headache;

thrombocytopenia;

itching of the skin;

peripheral edema;

leukopenia;

skin rash;

alopecia;

anaphylactic shock;

general malaise;

gynecomastia.

Overdose

Interaction with other drugs

special instructions

Omeprazole or Omez?

"Omeprazole" has an analogue with a similar name - "Omez".

A distinctive feature of "Omez" from the analogue drug is the country of origin. Omeprazole is produced in Russia, when Omez comes from India, this affects the price of medicines to a greater extent. "Omez" was released earlier than its analogue, so it is an original medicine. The doctor prescribes "Omez" or its generic, based on the severity of the course of the disease, since the original drug uses more effective substances, then "Omez" has more advantages over "Omeprazole".

Analogues

Pharmacy chains offer a large selection of analogues of the drug "Omeprazole", which have the same active ingredient, but differ significantly in price. Generic drugs include the following:

"Ocid";

"Gastrozol";

"Omezol";

"Bioprazole";

"Pepticum";

"Cerol";

"Ultop";

"Omephez";

"Losek";

"Upzol";

"Gasek";

"Omeprazole-Richter".

Do not self-medicate and neglect the recommended dosages, as this threatens with serious consequences in the form of side effects. Medicines for esophagitis are prescribed exclusively by the attending physician.

Treatment of reflux esophagitis with drugs

Reflux esophagitis is an inflammation of the esophageal mucosa due to the back reflux of the contents of the stomach and duodenum into it. The appointment of adequate treatment is important to prevent dangerous complications.

The symptoms associated with reflux cause severe discomfort to the patient and markedly impair quality of life. With reflux, there is not only heartburn, pain, but also the risk of developing adenocarcinoma of the esophagus.

Signs of reflux esophagitis

Gastric juice has a low pH value, which indicates its acid reaction. Its entry into the alkaline environment of the esophagus causes symptoms of pain and discomfort in the xiphoid process or epigastrium.

Reflux disease is manifested by frequently recurring symptoms:

Heartburn after eating, especially after taking fatty or hot foods, coffee and alcoholic drinks.

Sour eructation or belching of air, feeling of nausea.

Lump in throat, difficulty swallowing.

Pain behind the sternum after eating.

Symptoms of this disease are markedly increased when a person lies down after eating.

Principles of treatment

The causes of reflux and its treatment are inextricably linked, and therapy should be comprehensive:

First of all, normalize the mode of motor activity, nutrition. It is necessary to eat fractionally and in small volumes.

The next component of therapy is the use of medications that reduce the severity of symptoms. Their reception is carried out situationally. For example, for heartburn, patients are prescribed tablets and suspensions with an antacid effect (Phosphalugel, Almagel, Maalox, etc.).

There are drugs used for basic treatment. Reflux esophagitis requires the appointment of antisecretory drugs (omeprazole, pantoprazole, etc.). Gastroenterologists recommend taking prokinetics (Cerukal, Domperidone).

The doctor with esophagitis due to reflux should also try to treat the associated imbalance of the intestinal microflora. For this, probiotics and eubiotics are used, such as Hilak forte.

Almagel Maalox

Symptomatic treatment

The most common symptoms of reflux esophagitis include heartburn and epigastric pain. To stop these manifestations, gel antacids with anesthetics should be prescribed.

These preparations contain aluminum salts, which make it possible to create a film. By these means, the neutralization of the acidic contents that have entered the esophageal cavity is achieved.

These medications should not be taken for more than two weeks. During the day, these drugs are taken often: up to 3-4 times. This is due to the fact that the therapeutic effect after taking the drug lasts no more than 4-6 hours.

For pain

With severe pain, Almagel A should be taken with an anesthetic effect. This tool has a more pronounced effect than just Almagel.

Medications for pain relief and healing of the mucosa with erosions: Drotaverine, Solcoseryl, sea buckthorn oil, Actovegin, pantothenic acid.

Sorbents

In the medical treatment of reflux esophagitis, it is necessary to use adsorbents. This group of drugs has a therapeutic effect by binding bile acids and other aggressive components of gastric or duodenal contents.

In addition, such drugs reduce the severity of the clinical manifestations of esophageal reflux by forming a kind of film. These medicines should be taken according to the situation, but not longer than a week.

For nausea

With severe nausea and the urge to vomit, Cerucal injections can be given to the patient. An injection with this compound depresses the center of vomiting and eliminates unpleasant symptoms. The dose of the drug is the average therapeutic dose, according to the instructions for the drug.

Basic treatment, main course

After the symptoms of damage to the esophagus subside, doctors prescribe the main therapy. It includes the use of antisecretory drugs. These drugs are effectively used for long-term treatment of pathology.

Reflux esophagitis can occur in two ways.

With the formation of erosion.

No mucosal defects.

Regardless of the form, reflux esophagitis should be treated with antisecretory agents. They are aimed at reducing acid formation in the stomach. The aggressive factor becomes weaker, the symptoms are eliminated, conditions are created for the healing of the mucous membrane of the organ in the presence of erosive defects.

Let's talk about the drugs that are most often used to treat esophagitis. The first line is proton pump inhibitors. These include:

Omez;

Rabeprazole;

Lansoprazole;

pantoprazole;

Any of these drugs is effective and efficient in the fight against acid aggression.

To cure the erosive variant, it is necessary to take proton pump inhibitors at least twice a day. The dosage must be adequate. It depends on the presence / absence of erosion. For example:

Omeprazole should be taken twice a day (morning, evening) at 20 mg.

Lansoprazole is prescribed at 30 mg, taken twice a day.

The dosage and frequency of administration is chosen only by the doctor, depending on the situation!

A form of reflux esophagitis without the formation of mucosal defects requires the following use of drugs:

The course of treatment takes place within a month.
Proton pump inhibitors are taken once a day.
The dosage of other drugs can be from 10 mg to 40 mg. The amount depends on the characteristics of the inflammatory process and is chosen by the doctor.

The question of whether it is possible to replace drugs of this group with histamine blockers can only be answered by the attending physician, who will take into account the indications and contraindications.

To restore the microflora of the digestive tract, probiotics (Hilak forte) are used. They are needed because the presence of reflux changes the composition of bacteria in the intestine. Hilak forte eliminates the developed complications in the form of dysbiosis.
Motility disorders of the esophagus, stomach and various parts of the intestine often accompany reflux esophagitis. Treatment includes prokinetic drugs. These include Domperidone and Metoclopramide, Motilium.
In the presence of reflux, not only esophagitis often occurs, but also gastritis. In this situation, helicobacteriosis joins. Treatment requires a course of eradication therapy, including antibiotics, antisecretory agents. You can prescribe drugs with a cytoprotective effect, such as Trimedat.

Typical treatment regimens

Therapy with one drug. Such a scheme is far from the most effective, because individual symptoms are not taken into account.
dynamic therapy. Different drugs are prescribed depending on the intensity of the inflammatory process. Treatment involves a strict diet and taking antacids. If there is no effect, stronger drugs are prescribed, similar in principle of action.
The third regimen involves taking strong proton pump blockers. When severe symptoms go away, weak prokinetics are taken.

Folk methods and homeopathy

These two concepts should not be confused. Homeopathy is a complex of therapeutic effects based on the fact that like can be cured by like. That is, when using drugs that cause the same changes that are observed in the disease, it is likely to be cured or significantly alleviate the condition and symptoms. The homeopathic approach is not supported by all doctors, as there is a danger of causing serious complications.

Folk methods are based on the principles of traditional medicine, but plants and their parts are used. For example:

Celery root. Juice drink on an empty stomach for 1 tbsp. spoon 30 minutes before meals.
Collection of herbs: chamomile flowers (1 teaspoon), bitter wormwood (2 teaspoons), mint (2 teaspoons). Pour this mixture into 1 liter of boiling water. Then let stand for two hours. The healing infusion is filtered. Take 1/2 cup 30 minutes before meals.

Dill seeds. Take 2 teaspoons of seeds and grind. Brew with one glass of boiling water. Let it brew for 2-3 hours, filter. Take 1 tbsp. spoon 4 times a day.

Basically, the application is found by means that reduce acid formation in the stomach.

What drugs are used in the treatment of reflux esophagitis?

Treatment of reflux esophagitis is a rather capacious and complex process that requires the patient to strictly comply with medical prescriptions and seriously correct their lifestyle. To cure reflux esophagitis, the patient needs to give up bad habits and strictly take the pills prescribed by the doctor, among which the most common are Omez, Almagel, De-Nol and Motilium.

Usually, the treatment of the disease is carried out with medication in compliance with a strict diet. In some cases, during the diagnosis of reflux esophagitis, specialists use surgical intervention.

The main symptom of reflux esophagitis is severe heartburn, which manifests itself at any time of the day immediately after eating and requires medication to stop the burning sensation. Quite often, patients note the occurrence of pain in the sternum, which resemble heart pain. In some situations, the symptoms do not appear at all, but only swallowing is disturbed, and the person attempts self-treatment with drugs, which only worsens the condition.

Gastroenterologists distinguish several more signs of the disease:

Belching with acidic contents or air;
Pathology of the passage of food, failures of the swallowing reflex;
A persistent cough with reflux esophagitis, provoked by clogging of the bronchi with mucus, can be pacified with medicines;
Destruction of tooth enamel.

Treatment with drugs for reflux esophagitis requires their appointment by a qualified doctor.

Antacids for reflux esophagitis

Reflux esophagitis can last several years without the use of drugs, and over time it becomes complex. That is why, in order to detect the disease, a number of studies are carried out in time to detect HH:

Examination of the esophagus with an endoscope;

X-ray and biopsy of the esophagus;

Determining the level of acidity, which can be reduced by using antacid preparations (for example, Almagel. De-Nol).

Antacids are the most commonly used medications in tablet form.

The main direction of conservative treatment is the use of antacids and diet. In addition, patients are prescribed antisecretory agents (Omez) and prokinetics (Motilium), which improve gastric motility.

Diet and regimen for reflux esophagitis - after eating, you should not lean forward and lie down. In addition, you can not wear tight belts and clothes that restrict movement. To avoid taking drugs, you need to stop eating at night. You should also limit the amount of products that irritate the mucous membrane.

The use of antacids and alginates - antacids, which include Almagel and De-Nol, reduce the aggressive effects of gastric juice by increasing the pH level in the stomach. In case of detection of GERD, it will be more convenient to use drugs in gel form. The standard regimen for taking tablets during treatment involves taking them three times a day. Each patient should understand that heartburn with reflux esophagitis cannot be tolerated, so it must be stopped with medications.

Antisecretory drugs in the case of GERD (Omez) are directed to reduce acidity. Today, pharmaceuticals offer people a huge selection of drugs that actively suppress the activity of gastric secretion. It should be understood that the use of Omez cannot eliminate reflux esophagitis, but it helps to heal wounds.

Prokinetics (Motilium) during the treatment of reflux esophagitis improve the motility of the digestive tract. Under the influence of such medications, the receptors that provoke vomiting are blocked. Today, Motilium, which is an antagonist, is quite actively used.

It is very important to remember that any medicine for reflux esophagitis in the form of tablets should be washed down with plenty of water.

Treatment of reflux esophagitis with medication, exercise therapy

In addition to prescribing drug treatment with drugs of various groups, patients are advised to do exercise therapy and follow a diet.

The list of prohibited foods includes those that provoke an increase in the acidity of gastric juice. In this case, it is necessary to exclude the use of pastries and broths, spicy and fatty foods. To help antacid drugs and other medications have the desired effect, you should eat lean meats and fish, stewed vegetables and cereals. You should also avoid drinking juices that can contain acid that provokes stomach irritation.

Meals should be fractional and frequent, and after eating you can not immediately sit down and lie down.

Omeprazole - use as prescribed by a doctor

Diseases of the digestive system often develop against the background of high acidity of gastric juice. In such cases, omeprazole is often included in the complex treatment of patients. The use of omeprazole can significantly alleviate the condition of patients who are always concerned about abdominal pain Abdominal pain: types and symptoms. heartburn and sour belching Belching: why it happens and what it means.

The use of omeprazole in gastric and duodenal ulcers

Take omeprazole once a day before meals, in the morning. With gastric ulcer, 20 or 40 mg per dose for a month. If there is an improvement, but the ulcer has not completely healed, then the course of treatment is repeated. In duodenal ulcer, the same dose of omeprazole is taken for two weeks and, if necessary, the course is repeated.

If the goal of treatment is to eliminate Helicobacter pylori from the body, then omeprazole is prescribed 20 mg twice a day for two weeks along with antibacterial drugs.

The use of omeprazole in reflux esophagitis

Between the esophagus and the stomach is a circular muscle - the sphincter, which blocks the possibility of the acidic contents of the stomach entering the esophagus. But in some cases, the sphincter does not work and the contents of the stomach enter the esophagus, irritating its walls. If at the same time the acidity of the gastric juice is increased, the inflammatory process in the esophagus develops quickly and is difficult. This disease is called reflux esophagitis.

The walls of the esophagus with reflux esophagitis first become inflamed, then the inflammatory process can become purulent with the formation of multiple small abscesses and phlegmon. Pustules open and the surface of the walls of the esophagus is covered with ulcers. It is even possible to perforate the wall of the esophagus, as well as bleeding from the blood vessels feeding the esophagus.

Patients with reflux esophagitis experience terrible suffering. They are worried about constant heartburn, which turns into burning and pain behind the sternum, sour eructations. In the later stages of the disease, blood clots and pus are burped along with food masses.

Omeprazole can alleviate the condition of patients with reflux esophagitis: lowering the acidity of gastric juice will reduce heartburn and irritation of the walls of the stomach, which will ultimately contribute to the remission of the disease.

Omeprazole is prescribed in courses of 20 mg once a day for a month. If necessary, the course of treatment can be repeated.

What other diseases are prescribed omeprazole

Ulcerative processes in the walls of the stomach can be the result of stress or taking various medications. So, very often stomach ulcers develop in patients with rheumatoid arthritis who constantly take non-steroidal anti-inflammatory drugs (NSAIDs - aspirin, diclofenac, indomethacin, etc.) to relieve joint pain Joint pain - how to figure out what's going on? .

In order to reduce irritation of the stomach wall, such patients are prescribed courses of omeprazole. In the treatment of the ulcerative process, it is prescribed 20 mg once a day for a month, if necessary, the course of treatment is repeated. For the prevention of ulcerative process, omeprazole is prescribed along with NSAIDs throughout the course of treatment.

Another indication for taking omeprazole are diseases of other organs and systems, accompanied by increased secretion. For example, Zollinger-Ellison syndrome is a benign tumor of the pancreas. Diabetes and the pancreas are things to know. which produces gastrin, which stimulates the secretion of gastric juice. The disease can be severe, while omeprazole is prescribed in individually selected dosages, the duration of treatment courses is also individual.

Galina Romanenko

Maev I.V. Goncharenko A.Yu. Kucheryavy Yu.A. Efficacy of omeprazole and rabeprazole monotherapy in elderly patients with erosive reflux esophagitis // Clinical perspectives of gastroenterology, hepatology. - 2007. - No. 2. - p. 31–36.

Efficacy of omeprazole and rabeprazole monotherapy in elderly patients with erosive reflux esophagitis

I.V. Maev, A.Yu. Goncharenko, Yu.A. Curly

In developed countries, there is a tendency to increase the average age of the population, the incidence of gastroesophageal reflux disease, the frequency of its severe and complicated forms in the elderly. In this regard, it is especially important to study the pharmacotherapy of reflux disease in this category of patients. In a prospective randomized crossover study, a comprehensive analysis of the effectiveness of monotherapy with proton pump inhibitors (omeprazole, rabeprazole) in elderly patients with erosive reflux esophagitis was performed. The study involved 78 patients aged 65 to 81 years. The results of daily monitoring of pH in the esophagus and stomach, the frequency and severity of symptoms and epithelialization of esophageal erosions showed that rabeprazole has a more powerful antisecretory effect. This circumstance suggests that in the treatment of patients with erosive reflux esophagitis in the elderly, rabeprazole is preferable as the most effective proton pump inhibitor.

Keywords: gastroesophageal reflux disease, reflux esophagitis, proton pump inhibitors, omeprazole, rabeprazole, treatment.

Interest in gastroesophageal reflux disease (GERD) is determined primarily by its prevalence and the increasing incidence of this pathology. Diseases of the esophagus, including GERD and diaphragmatic hernia, in the elderly are significantly associated with changes, including a weakening of the activity of cholinergic systems and a relative increase in the function of the sympathoadrenal regulatory system, atherosclerotic vascular lesions and, ultimately, a decrease in the trophism of the mucous membrane (SO), weakening of its protective mechanisms.

Gastrointestinal bleeding in 21% of the elderly was due to erosions and ulcers of the esophagus. In addition, older people are more at risk of carcinogenesis, as they have weakened defense mechanisms against the action of factors of aggression on the esophageal mucosa associated with GERD. The decrease in reparative capabilities during human aging slows down the healing of SO defects.

There are only a few works devoted to the problems of GERD in the elderly. So, it was shown that the frequency of detection of this disease increases with age. There are more severe injuries of the esophagus than at a young age. The results of studies in recent years indicate a higher incidence of gastroesophageal reflux in the elderly, associated with a significant shortening of the intra-abdominal segment of the esophagus and lower esophageal sphincter.

So far, there is no consensus on the most rational therapy for this category of patients. As in other age groups, proton pump inhibitors (PPIs) are the drugs of choice, the effectiveness of which significantly exceeds that of antacids, prokinetics, and histamine H2 receptor blockers.

However, even with the use of PPIs in elderly patients, a rapid clinical effect, as in young and middle-aged patients, is not observed. In part, this can be explained by significant changes in microcirculation in patients with GERD in this age group.

Rice. 1. Study design: Rabe 20 — rabeprazole at a dose of 20 mg/day, Ome 40 — omeprazole at a dose of 40 mg/day

Another possible reason is changes in the liver, characterized by a decrease in its size and mass, a decrease in hepatic blood flow, the number of hepatocytes and the development of their compensatory hypertrophy. These circumstances change its functional state and disrupt the metabolism of a number of drugs during the first passage through this organ, which must be taken into account in the pharmacotherapy of the elderly.

Potential reasons for the lower effectiveness of PPIs in the elderly also include a higher incidence of hiatal hernia and body mass index values compared to those in young and middle-aged patients.

In recent years, many studies have been conducted indicating the high efficacy of rabeprazole (pariet) in the treatment of GERD, which is due to its good clinical tolerance, a minimum of side effects, safety of use, rapid conversion to the active form, a significant severity of antisecretory action from the first day of administration and the possibility its use as needed or on demand (pro re nata) and a lower effective dose.

The aim of our study is a comprehensive analysis of the effectiveness of monotherapy in elderly patients with GERD with various PPIs (omeprazole, rabeprazole).

Material and research methods

An open comparative study was conducted, which included 78 patients (37 men and 41 women) aged 65 to 81 years (mean age 72.2±2.8 years). To implement the tasks set, we used the method of cross-sectional analytical study from the standpoint of evidence-based medicine (prospective randomized crossover).

The design included two stages (Fig. 1) of the study.

Stage 1 - diagnostic (clinical and instrumental):

clinical screening for GERD;

instrumental verification of GERD - esophagogastroduodenoscopy, chromoendoscopy of the esophagus, morphological study of biopsy specimens of its SO, daily pH monitoring in the esophagus and stomach Gastroscan-24);

comprehensive examination of patients (clinical and laboratory blood and urine tests, assessment of electrophysiological characteristics and organic changes in the cardiovascular system - ECG, daily ECG monitoring, bicycle ergometry, treadmill test, echocardiography, ultrasound examination of the abdominal organs, chest radiography, fluoroscopy of the esophagus and stomach)

formation and randomization of observation groups in accordance with the criteria for inclusion in the experiment and exclusion from the study;

monotherapy with various PPIs per protocol using a crossover design.

2nd stage - analytical - evaluation of the effectiveness of monotherapy with various PPIs according to clinical and endoscopic data (prospective randomized crossover study), statistical analysis.

Criteria for inclusion in the study:

age over 65;

heartburn or (in its absence) 2 or more symptoms characteristic of GERD: dysphagia, odynophagia, regurgitation, pain and feeling of "coma" behind the sternum, chronic cough;

duration of complaints for at least 6 months;

erosive reflux esophagitis;

informed consent of the patient to participate in the study.

Criteria for exclusion from the study:

intolerance to rabeprazole and omeprazole;

taking any antisecretory drugs 4 weeks before the start of the experiment;

severe concomitant diseases in the decompensation stage, which determine the severity of the condition and prognosis for life and limit diagnostic studies, surgical interventions on the esophagus and stomach, peptic ulcer of the stomach and duodenum in the acute phase, other diseases of the esophagus (achalasia, diverticula, cancer, ulcers, cicatricial strictures impassable for the endoscope, bleeding from erosions during the study).

From the moment of admission to the hospital, patients took only antacids (phosphalugel) in the on-demand regimen no more than 4 times a day. As the diagnosis was clarified (clinically, endoscopically, pH-metrically), patients with GERD were randomly (using the envelope method) included in subgroups taking various PPIs in accordance with a crossover design. The choice of this protocol was due to the need to minimize the possible errors of the method due to the unknown polymorphism of the CYP2C19 gene in patients (which significantly determines the effectiveness of PPIs), the unknown level of infection with Helicobacter pylori (definitely affecting acid formation), the heterogeneity of groups of patients due to their parallel intake of a number of cardiac and other drugs that potentially affect the course of GERD.

A crossover randomized prospective study traditionally took place in 2 phases with a total duration of 8 weeks (phases 1 and 2 - 4 weeks each, a break between phases - 7 days). The duration of PPI therapy was in line with the recommendations of the Russian Gastroenterological Association. The doses of the drugs were standard and did not change throughout the study: omeprazole 40 mg/day and rabeprazole 20 mg/day.

Between the phases of the study, patients received only antacids for 7 days ("washout" period) (phosphalugel in the on-demand mode, no more than 4 sachets per day).

Thus, during the study, each patient received both rabeprazole (20 mg/day) and omeprazole (40 mg/day), only in a different sequence, which allowed further pair analysis of the results of the effect of drugs on the manifestation of clinical symptoms of GERD, gastric secretion and healing of esophageal erosions.

All symptoms (complaints) indicating GERD (both typical and extraesophageal, with the exception of dental ones) were analyzed - heartburn, dysphagia, odynophagia, regurgitation, pain and a feeling of "coma" behind the sternum, chronic unproductive cough both during the initial visit and during dynamics during therapy.

In order to objectively assess the manifestations of the disease and the dynamics of the pathological process, a conditional scale for the quantitative assessment of GERD symptoms was used, calculating the average severity of a particular sign:

- 0 points - no symptom,

- 1 point - the symptom is mild (rare episodes that do not require medication);

- 2 points - the symptom is moderately pronounced (requires medication, but does not significantly interfere with the patient's daily activity);

- 3 points - the symptom is severe (requires a break in the performance of normal activities, taking medication and contacting a doctor).

Considering that some symptoms did not occur every day, and their severity varied, we calculated the average score of symptoms that appeared in the last 2 weeks of observation.

When analyzing the results of 24-hour pH monitoring during a cross-sectional study of PPI efficacy, the total time of pH in the esophagus was below 4 and the percentage of the time of day when the pH in the corpus was above 4 was taken into account.

For statistical data processing, mathematical modules "Access Microsoft Office XP" were used. Statistical analysis was carried out using the Statistica-release 6.0 program (StatSoft, USA).

Rice. 2. Dynamics of the frequency of clinical manifestations of GERD during therapy, %. The significance of differences between the subgroups treated with omeprazole and rabeprazole is marked with an asterix (asterisk - *, p< 0,05)

Research results and discussion

During the "washout" period, 2 patients refused further study due to deterioration and recurrence of complaints on the background of antacid treatment, 7 dropped out of the experiment in the process of PPI monotherapy for various reasons (failure to appear for a control examination within the agreed time frame, deviation from the therapy regimen, arbitrary refusal to continue the experiment). 69 patients completed the protocol.

To identify the dynamics of complaints against the background of PPI monotherapy in elderly patients with GERD, a comparative analysis of the frequency of occurrence of symptoms was carried out (Fig. 2).

In the vast majority of patients included in the protocol of the cross-sectional study, after the rabeprazole test in the "washout" period, recurrence of complaints was noted. The frequency of occurrence of this or that complaint by the beginning of PPI pharmacotherapy approximately corresponded to that during the initial examination of patients.

Analysis of symptoms against the background of PPI monotherapy in elderly patients with GERD showed a significant decrease in the frequency of registration of complaints in both groups. However, if a significant reduction of all the listed symptoms while taking rabeprazole was achieved, then with monotherapy with omeprazole, the incidence of regurgitation and chronic cough, although it decreased, but without statistically significant differences from baseline.

When comparing the frequency of complaints at the end of rabeprazole and omeprazole, significant differences were revealed: almost all analyzed symptoms were observed much less frequently when taking rabeprazole (p<0,05).

No less significant than the dynamics of the frequency of registration of complaints was the determination of the semi-quantitative characteristics of symptoms during therapy (Fig. 3).

An analysis of the dynamics of symptoms in points confirmed the previously identified trend: omeprazole and rabeprazole effectively eliminate the symptoms of GERD in the elderly. As noted in fig. 3, by the end of the 4-week course of PPI therapy, all GERD symptoms were significantly reduced relative to baseline values. At the same time, there was a significantly more pronounced effectiveness of rabeprazole in the "control" of symptoms, since they were significantly less pronounced than when taking omeprazole.

Thus, analyzing the dynamics of complaints and the degree of their severity against the background of monotherapy with various PPIs, it can be concluded that rabeprazole "controls" the symptoms of GERD in the elderly better than omeprazole.

According to the study protocol, daily monitoring of pH in the esophagus and stomach was carried out in patients with GERD 4 times - on the 1st and 28th days of taking each PPI. When analyzing results during a cross-sectional study of the effectiveness of PPIs, the total time of pH in the esophagus was below 4 and the percentage of the time of day when the pH in the body of the stomach was above 4 was taken into account.

Rice. 3. The severity of GERD symptoms in points during therapy. The significance of differences between the subgroups treated with omeprazole and rabeprazole is marked with an asterix (asterisk - *, p<0,05)

Against the background of therapy with rabeprazole and omeprazole on the first day, the pH time< 4 в пищеводе составило 318,7±12,1 и 414,2±15,7 мин соответственно (рис. 4).

Thus, the analysis of this indicator during the first day of therapy showed a greater severity of the antisecretory effect of rabeprazole (p<0,05). При контрольном исследовании на 28-е сутки отмечено дальнейшее достоверное снижение среднесуточного времени рН < 4 до 78,4±9,7 и 146,9±12,4 мин в группах больных ГЭРБ, получавших рабепразол и омепразол соответственно (р<0,05).

A similar trend, indicating a more pronounced antisecretory effect of rabeprazole, was also noted in the analysis of the average values of the percentage of time pH > 4 in the stomach (Fig. 4). Both on the first day and on the 28th day of taking rabeprazole was statistically significantly more effective in suppressing gastric acid production (p<0,05).

Rice. 4. Results of daily pH monitoring in patients with GERD during therapy. The significance of differences between the subgroups treated with omeprazole and rabeprazole is marked with an asterix (asterisk - *, p<0,05)

During the 1st phase of the study, against the background of treatment with rabeprazole, epithelization of erosions did not occur only in 1 patient out of 35, while when taking omeprazole, healing of erosions was absent in 6. A comparative analysis of the frequency of epithelization of erosions showed the advantage of rabeprazole: the frequency of epithelization of erosions was 14 .7% higher. However, there were no statistically significant differences between the groups, which may be due to the small number of patients in the groups (see table).

Endoscopic examination at the end of the 2nd phase showed that in all patients with no healing of erosions in the 1st phase, when taking omeprazole in the 2nd phase, their complete epithelialization was achieved. At the same time, in the 2nd phase, while taking omeprazole, the number of patients with erosive esophagitis not only did not decrease, but also increased by 4 times. These facts indirectly confirm the trends we have identified: rabeprazole not only reliably "controls" the symptoms of GERD and acid formation in the stomach, but also contributes to the epithelization of esophageal erosions to a greater extent.

Reflux esophagitis exists in different forms and degrees of severity. The treatment for each degree is different, so the time allotted for the relief of the inflammatory process is individual in each individual case.

If the patient was diagnosed with GERD, and at the same time reflux esophagitis has developed, he is prescribed drugs of various directions.

Antacids. Their effect significantly suppresses the aggression of gastric acid on the soft tissues of the esophagus. The most common types are usually prescribed, these are almagel, gastal, phosphalugel.

Antisecretory agents. When taken regularly, they normalize the acidity of the juice in the stomach. This group includes drugs such as pantoprazole, omitox, omeprazole. The latter type is often prescribed for long-term use, since the presence of reflux esophagitis does not allow a quick cure of GERD.

Prokinetics. Medications in any regimen in the treatment of esophagitis. They improve the motility of the entire gastrointestinal tract. Eliminate dysbacteriosis, normalize flora. This includes cerucal, mosax, motilium.

In addition to medicines, a specialist can prescribe vitamin complexes for several months. Such a move is considered support for the body when taking aggressive drugs.

Adherents of home treatment are sure that reflux can be treated with herbs without the intervention of medications. Herbalists claim that decoctions from plants can stop not only the symptoms of the disease, but also completely cure a disease such as esophagitis. This opinion is doubtful, it is not worth listening to it completely.

The course of therapeutic therapy should consist of drugs. Alternative methods are effective only at the initial stage and together with medicines.

To eliminate heartburn, it is necessary to take an herbal infusion of herbs such as:

Usually 400 grams of decoction is stretched for the whole day.

Note that self-administration of folk decoctions in the treatment of esophagitis can lead to both allergic reactions and complications in the gastrointestinal tract.

Nutrition for pathologies of the esophagus is an important point, since food is the first link that provokes any changes in the stomach. This disease involves constant monitoring of your diet, the right way of life. The diet for reflux must be strictly observed, since a relapse is possible with the slightest deviation.

Surgery for reflux is involved quite rarely, but still has a place to be. The operation is carried out in critical situations, such as:

lack of positive results after taking medication for 6 months;
recurrence of bleeding;
regular aspiration pneumonia;
complications in the esophagus that have arisen with the neglect of reflux esophagitis;
esophagitis of the last stage (the condition of the esophagus is characterized as affected by 50%);
occurrence of esophageal hernia.

The type of operation is individual for each patient. The type of intervention is determined by the doctor, taking into account all the symptoms and the general condition of the person.

Reflux esophagitis is treated for quite a long time. Drugs are prescribed not only to relieve symptoms, but also to further maintain the proper functioning of the esophagus. Medicines must be taken in groups. Taking one capsule will not save a person from the inflammatory process in the stomach and esophagus.

The most annoying and unpleasant symptom is heartburn. At the beginning of therapy, the specialist tries to eliminate its presence, since this unbearable condition does not allow a person to live normally. The fight against burning in the chest can continue indefinitely, here it is important to adhere not only to strict adherence to the intake of drugs, but also to proper nutrition.

It is also worth noting that not every scheme will immediately help. Perhaps at first the drugs will help, but then the condition abruptly returns to the initial manifestations. It is also important to catch this moment and visit the attending physician. He will replace the scheme, give additional recommendations. If the drug gives a good effect, you can take it for a long time.

The course of treatment therapy can reach 12-18 months.

Each doctor treats reflux esophagitis according to his own scheme. Someone adheres only to folk methods, others prescribe medications. Since esophagitis is not an independent disease, but only continues the main one, all therapeutic "efforts" come down to eliminating the symptoms, although the cause must be treated. As a result, therapy is delayed for many months.

For example, children with esophagitis are treated for a long time (1-3 months), then prophylaxis is carried out twice a year, usually in spring and autumn. Preventive measures include things like:

strict diet;
taking vitamins and antacids.

Reflux is treated for 3 months followed by supportive medical therapy.

Reflux can take years. Without proper treatment, the symptoms of the disease will only intensify. It is worth noting that this disease is quite successfully treated. But one fact is confusing - if you stop treatment, a relapse occurs (90%). This applies to those who begin the past way of life. Therefore, with reflux esophagitis, proper nutrition should be observed for life.

The duration of taking the drugs depends on the form of the disease. In a mild form, 3 types of drugs are prescribed (motilium with almagel, motilium with omeprazole). At advanced stages, you will need to take 3 groups of drugs for 3 months.

If the doctor has suspicions that the patient is developing Barrett's esophagus, he recommends that the patient undergo a special examination once every three years.

In order to forget about the symptoms of the disease for several years, you need to have iron willpower.

Do not forget about stress throughout life, holidays with delicious dishes on the table, lack of sleep, stress. All of these lead to reflux symptoms. In such cases, omeprazole is simply necessary. This is the only drug that can stop unpleasant manifestations without side effects for a long time. The main effect of therapeutic drug therapy is to remove the symptoms, to allow the body to get used to the new state. As a rule, it is impossible to completely cure reflux esophagitis, specialists are only trying to achieve a long and stable remission.

This factor plays a role. But even if a person meditates for several hours a day, while eating Big Macs, drinking them with water and gas, reflux will not go away.

There are many reasons for the occurrence of esophagitis, and for each patient they are different.

Surprisingly, even silver fillings can be a trigger.

Whatever they say, you need to take tests and start from the results. We also note that in our clinics a person will not achieve the desired result, so it is better to undergo an examination in a special clinic, a paid center. Expensive, but taking pills for life is even more expensive.

Diseases of the gastrointestinal tract are quite difficult to cure. Esophagitis is a condition when discomfort is always felt, it interferes with a normal life. In order not to experience it throughout your life, you should think about your health in advance, take appropriate measures.

Of course, you immediately need to give up bad habits, start dieting. You don't have to cut out your favorite foods completely, you can just keep them to a minimum. The usual amount of food eaten in one go can be split into two.

Possible treatments for the disease will be discussed in this video:

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Reflux esophagitis is a fairly common chronic disease, the main symptom of which is the ingress of stomach contents into the esophagus. Data from studies conducted in European countries indicate that every second inhabitant has such a pathology. However, most people suffering from this disease seek medical help only with the development of serious consequences. The most dangerous complications are an ulcer and cicatricial narrowing of the esophagus, which can be detected by the appearance of a sharp pain in the chest and impaired swallowing. As a result of a long course of esophagitis, a malignant transformation of mucosal cells can occur, and cancer will occur.

In this article, we will consider how to treat reflux esophagitis. Feedback will also be provided.

A competent approach to the treatment of reflux esophagitis is, of course, complex. In the pathology of the esophagus, the following recommendations exist.

moderate physical activity, which has a good effect on the body and complements the treatment of many pathologies, with a disease of this type excludes power loads and exercises, during which you need to lean forward.
Proper nutrition serves as the basis for the treatment of diseases of the digestive tract, prophylactically affects the exacerbation of pathologies of a chronic nature.
Medications, including those that fight the cause of the disease, and also help to remove clinical symptoms.
Preventive actions.
Adding physiotherapy during periods of exacerbations.

Currently, specialists use several treatment regimens for esophagitis, selecting each individually and taking into account all the results obtained during the diagnosis. How to treat reflux esophagitis? Reviews confirm that nutrition is of no small importance.

During the disease, throughout the treatment, you need to make it a habit to maintain a healthy lifestyle and diet. These are important components of the treatment regimen. A balanced and properly selected diet will help normalize the digestive tract, relieve inflammatory symptoms in the esophagus with esophagitis and reflux gastritis. There are reviews on this.

Before any meal, you should drink two hundred grams of cool non-carbonated liquid, thus protecting the mucous membrane of the esophagus.
You should eat two pieces of raw potatoes during the day, this reduces the production of gastric juice. White bread or a couple of nuts can serve as an analogue.
It is undesirable to drink alcoholic beverages, especially before meals.
You should not eat anything tasty at night, it is better to drink an infusion of chamomile before going to bed.
After eating, it is better to sit down, it is not recommended to lie down.
It is not recommended to wear tight clothing that squeezes the abdominal cavity.
Meals should be fractional, and portions should be small. After eating, you need to drink a glass of water.
The best drinks for patients are dried fruit compote, rose hips, low-fat milk.
In the patient's diet with inflammation, curd mass, light yogurt, kefir should be present, since these products normalize the functioning of the esophagus and stomach.
Of the cereals on the menu, you can leave only millet and oatmeal.
Fruits that help stop the symptoms of the disease are pears, plums, ripe peaches, bananas. It is better to use them in the morning or on an empty stomach.

Only a doctor can tell you exactly how to treat reflux esophagitis. Reviews confirm this.

The basic course of therapy for esophagitis is divided into two stages:

1) Erosive- duration eight weeks. Proton pump inhibitors (PPIs) are taken twice a day and the same amount - Omeprazole (20 mg each). Lansoprazole is prescribed in the morning and evening, the dosage is 30 mg. The most effective action has the reception of "Rabeprozol" (once a day). "Pantoprazole" and "Esomeprazole" are prescribed twice a day (40 and 20 mg, respectively). These funds will help if there is also reflux gastritis (according to reviews).

2) non-erosive- The duration of the course of treatment is one month. Take a PPI once a day. The dosage of other drugs varies from ten to forty mg. Their number is directly related to the severity of the inflammatory process.

After the main course of treatment is completed, maintenance therapy is necessarily prescribed, which serves as a good prevention. The vast majority of patients with this disease take drugs throughout their lives, thereby reducing the likelihood of a malignant tumor of the esophagus.

Judging by the reviews, reflux esophagitis is treated according to several schemes. The first treatment regimen consists in the use of one drug without taking into account all the symptoms, the presence of complications and the stage of soft tissue changes. This approach does not bring benefits, and sometimes it can even be harmful to health.

The second includes reinforcing therapy, when drugs of different intensity are prescribed at one stage or another of inflammation. You need to follow a diet and take antacids. In the absence of the desired effect, a combination of similar drugs is prescribed, but with a stronger effect.

In the third scheme, the patient takes intensive proton pump blockers, and as the symptoms subside, he uses weak prokinetics. Such a measure has a good effect on the health of patients with a severe form of pathology. How to treat esophagitis reflux (reviews indicate the presence of different treatment regimens) correctly? More on this later.

The first treatment regimen is to use the same medicine. This does not take into account the degree of change in soft tissues and pronounced symptoms, the presence of complications. This approach is not effective, in some cases it can be harmful to health. But what is the best way to treat reflux esophagitis?

The second approach is increasing therapy, which involves the use of drugs of different aggressiveness at various stages of the inflammatory process. With this type of treatment, you need to follow a diet and take antacids. If the desired effect does not occur, the doctor must prescribe a combination of similar drugs, but already having a stronger effect.

The third scheme is that the patient begins to use strong proton pump blockers. As soon as the pronounced symptoms subside, weak prokinetics should be used. This measure has a positive effect on the health of patients in whom the disease is observed in severe form. So far, in general, it is clear how to treat reflux esophagitis. The preparations will be presented below.

Reviews indicate that there is a classic scheme that has four stages, depending on the severity of the disease:

How to treat reflux esophagitis with pills? Treatment with medicines includes two stages. The first is that the esophageal mucosa heals and normalizes. The second method of treatment helps to achieve remission. The patient chooses one of three approaches at will:

taking inhibitors in high doses for a long time;
use in full dosage on demand in a short course (within five days);
prescribing medications only when symptoms are severe. The required dosage is taken once a week.

Reviews testify to the effectiveness of these schemes.

At the initial stage, the disease is treated only with a balanced diet. At other stages, only drug therapy saves. Experts recommend using several groups of drugs:

Antacids, reducing and neutralizing acidity, effective in combating heartburn (Almagel, Gastal, Rennie, etc.). They act within 10-15 minutes, are symptomatic, so the course should last no more than two weeks.
Prokinetics. Normalize the work of the lower sphincter, which passes food from the esophagus. The main active ingredient of this group of drugs is domperidone (Motilium, Motilak). Prokinetics improve the motor function of the stomach and more efficient muscle contraction, reduce the contact time of the esophagus and hydrochloric acid. It is appropriate to use them when feeling heaviness after eating.
Antisecretory drugs that reduce the production of acid ("Omeprazole", "Famotidine"). How to treat reflux esophagitis? Which tablets are better to choose? These questions should be asked to the doctor.

Symptomatic medications are used according to the indications of a doctor and can become part of the general treatment regimen for reflux esophagitis under certain conditions, if the cause of the development of the disease lies in continuous stress or neurosis. In this case, consultation with a psychotherapist, the use of sedatives is required. The peptic ulcer that accompanies this process requires the appointment of the drug "De-Nol".

The duration of treatment and the number of drugs used are determined by the severity of the inflammation. Most often, two drugs of different types are prescribed. Only a qualified specialist should do this, since the local therapist will not pay attention to all the criteria.

The main principle of maintenance treatment is to reduce the aggressiveness of drugs to the point where the signs of esophagitis are quickly eliminated. With erosion, the condition must be maintained with prokinetics, using a standard dose of the drug. This is true in the two early stages of the disease.

In severe cases, maintenance therapy consists of the continuous use of strong drugs, including blockers and prokinetics. Patients need frequent esophageal assessment to monitor soft tissue.

The goal of the experienced practitioner should be to promote healing of the esophageal mucosa. Then the doctor should stop with the help of medicines the main symptom of the disease - heartburn. The end result should be to improve the quality of life of patients. It is important to find out in a timely manner how to treat erosive reflux esophagitis so that there are no complications.

It is very important to remember that the drug is best washed down with a full glass of ordinary clean water. This will help to avoid the tablet getting stuck in the lumen of the esophagus and further irritation of the mucosa, because in this case the remedy does not enter the stomach and, accordingly, does not have a therapeutic effect.

It is undesirable to abuse the use of painkillers, as this will only aggravate the situation. The continuous use of analgesics and the sudden withdrawal of them can worsen the patient's condition. Reviews confirm this. In such a case, the doctor may provide the patient with a plan for consistently avoiding pain medication.

Food additives containing iron in their composition are also unacceptable.

Thus, the therapy of reflux esophagitis should be complex. Self-medication is not worth it, because only a qualified specialist is able to choose the right scheme for eliminating the symptoms of the disease, taking into account the diagnostic data and clinical manifestations. You can get high-quality results and get rid of the disease only with the strict execution of everything that the doctor prescribes. We took a detailed look at how to treat acid reflux esophagitis.

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In any pharmacy there is a wide range of medicines for gastrointestinal diseases. Many of them are popular and loved by the population, as they help get rid of digestive problems. One such problem is reflux esophagitis. This disease is chronic and is characterized by the release of undigested food from the stomach into the esophagus, the mucous membrane of which is not protected from such an aggressive environment. This pathology is accompanied by discomfort, burning and pain. Inflammation may begin. Omeprazole for reflux is one such drug.

In the pharmacy chain, Omeprazole can only be found in capsules, the shell of which dissolves easily in the intestines.

In addition to the main active ingredient, the composition of the drug includes such components as: glycerin, gelatin, methylparaben, dyes and other fillers.

Omeprazole, dissolving in the intestine, penetrates into the cells responsible for the production of gastric juice and enzymes that help digestion. The principle of action of the drug lies in the regulation of these processes, and it also contributes to the destruction of Helicobacter bacteria. The course of treatment of reflux esophagitis with omeprazole is aimed specifically at normalizing the microflora of the stomach. and decreased gastric acid production.

People with fructose intolerance;
The patient suffers from renal insufficiency, the combination of Omeprazole and Clarithromycin is unacceptable;
From reflux, drinking Omeprazole is not recommended for pregnant women and during lactation;
It is forbidden to give medicine to children whose age is less than 5 years;
In case of individual intolerance to any component of the drug.

The use of omeprazole can cause the following side effects:

Intestinal disorder. Possible diarrhea or constipation;
urge to vomit or nausea;
allergic reactions;
Flatulence with painful sensations;
Pain in joints and muscles;
Deterioration of mood;
dry mouth;
Liver problems.

If you turn to the instructions, then it is written in detail how to use Omeprazole for reflux esophagitis, gastritis, peptic ulcers of the gastrointestinal tract and other diseases of the digestive system. For effective treatment, it is recommended to strictly follow the doctor's prescription and not violate the time interval for the drug to enter the body.

The drug is not tied to breakfast, lunch or dinner. The recommended dose of the drug is 20 mg, but in case of a severe course of the disease, the doctor may double the dosage. The course of treatment reaches two months.

If you strictly follow the prescriptions of the attending physician and do not skip taking the drug, or do not arbitrarily increase the dose, but take Omeprazole strictly according to the scheme, then the result appears in a fairly short time. Within an hour, there is a significant relief of the condition, which is maintained throughout the day.

It has been established that the treatment of patients with gastroesophageal reflux disease with the help of omeprazole brings good results. Significantly reduced symptoms, and after a while there is a complete relief of the condition.

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HE. Minushkin, L.V. Maslovsky, Yu.N. Loshchinina, N.Yu. Anikina,
Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation

In developed countries, the incidence of gastroesophageal reflux disease (GERD) has been steadily increasing in recent years. Up to 10% of the population experience GERD symptoms daily, 30% weekly, and 50% monthly. The trend towards an increase in the incidence of GERD was the basis for proclaiming the slogan "XX century - the century of peptic ulcer, XXI - the century of GERD" at the 6th European Gastroenterological Week.

Russian studies conducted within the framework of the WHO MONICA program in Novosibirsk showed a frequency of GERD comparable to the above data. Heartburn is experienced by 61.7% of men and 63.6% of women, with 10.3% and 15.1% often or constantly (5). The results of our own studies, based on a retrospective analysis of the primary conclusions of EGDS in 5107 gastroenterological patients over a 5-year period, showed that endoscopic signs of reflux esophagitis were detected in 1419 patients (27.8%), of which 880 were men (28.8%) and 539 women (26.3%) (percentage given of the total number of men or women). Catarrhal esophagitis was detected in 890 patients (17.4%) - 538 men (17.8%) and 352 women (17.2%). Erosive esophagitis - in 529 examined (10.4%) - 342 men (11.2%) and 187 women (9.1%).

Adequate treatment of GERD is necessary, as this disease impairs the quality of life of patients, and the prolonged existence and progression of esophagitis can lead to the development of strictures, Barrett's esophagus, and esophageal cancer.

Treatment of GERD includes recommendations for changing the patient's lifestyle and drug therapy (2). In patients without esophagitis, the goal of treatment is to relieve symptoms associated with acid reflux (heartburn, sometimes chest pain) and improve quality of life. In the presence of esophagitis, treatment is also carried out to prevent the development of complications such as esophageal stricture or epithelial metaplasia (Barrett's esophagus).

In all variants of GERD, the initial treatment includes a set of measures for drug-free therapy (raising the head end of the bed, weight loss, dietary restrictions, etc.) and taking antacids. If symptoms persist against this background, drug therapy is connected for 2-4 weeks. Proton pump inhibitors are the most preferred initial drug therapy. The data available to date indicate approximately the same clinical efficacy of various representatives of this group of drugs (omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole) (9, 11). A number of studies indicate some superiority of esomeprazole over omeprazole in terms of the degree of suppression of gastric secretion and the rate of onset of the effect (10). However, these differences may be due to different dosages of drugs (40 mg and 20 mg, respectively).

Own experience of course treatment of 115 patients (77 men, 38 women, mean age 45.1 ± 1.2 years) with 0-4 degree GERD with omeprazole, esomeprazole, rabeprazole in standard doses for 4 weeks showed high clinical and endoscopic efficacy of all studied patients. drugs (6, 7, 8).

The dynamics of the clinical and endoscopic picture is presented in tables 1 and 2.

The number of patients with complete healing of erosions after 4 weeks of treatment with various PPIs, depending on the degree of reflux zzophagitis

Percentage of patients with complete relief of heartburn after 4 weeks of treatment with various PPIs

The presented data testify to the high efficiency of all drugs used in the treatment of erosive esophagitis, there were no significant differences in the number of patients with complete healing of erosions after 4 weeks of treatment using Omez, Pariet or Nexium. A similar picture was observed in relation to the relief of symptoms, in particular heartburn. Table 2 shows that Omez has some advantage.

Omez was used to evaluate the effectiveness of various maintenance regimens. One of the reasons for this choice was that Omez is one of the most available proton pump inhibitors in Russia and is as effective as other proton pump inhibitors on the Russian pharmaceutical market.

We have evaluated the effectiveness of 4 regimens of maintenance therapy with Omez (omeprazole) at a dose of 20 mg for 12 months in patients with GERD 0 and 1 stage. upon reaching clinical and endoscopic remission during course treatment:
1) taking Omez at a dose of 20 mg/day daily (group 1 - 20 patients);
2) taking Omez at a dose of 20 mg/day every other day (group 2 - 20 people);
3) taking Omez at a dose of 20 mg in the "on demand" mode: 20 mg / day for heartburn (group 3 - 20 patients);
4) taking Omez at a dose of 20 mg in the "weekend" mode: 20 mg / day on Friday, Saturday and Sunday (Group 4 - 15 patients);
5) control group - patients who did not receive maintenance therapy (group 5 - 30 patients).

A total of 105 patients were admitted to the study: 62 men (59%) and 43 women (41%). All patients belonged to the European race. The characteristics of the group are presented in table 3.

Characteristics of the studied patients

Before inclusion in the study, all patients underwent endoscopy (table 4), the severity of symptoms and quality of life were assessed. Clinical and endoscopic control was carried out every 3 months. The assessment of the degree of GERD in EGDS was carried out according to the Savary-Miller classification modified by Carisson et al. Patients kept a daily diary in which the intensity of symptoms was assessed on a Likert scale, and a visual analogue scale (VAS) was used to assess quality of life. Patients received full-dose PPI course treatment until clinical and endoscopic remission was achieved, after which they were prescribed maintenance therapy with Omez in one of the regimens.

Distribution of patients into groups depending on the degree of GERD

Group	The degree of GERD with endoscopy
Group	GERD grade 0	GERD 1 degree
Group 1(n=20)	9 (45%)	11 (55%)
Group 2(n=20)	8 (40%)	12 (60%)
Group 3(n=20)	11 (55%)	9 (45%)
Group 4(n=15)	7 (46,6%)	8 (53,3%)
Group 5(n=30)	13 (43,3%)	17 (56,6%)

Group distribution was random. The patients of each group were comparable in terms of age, disease duration, body mass index (BMI) and a number of other features (Table 5).

Characteristics of patients in the study groups

Evaluation of the effectiveness of maintenance therapy according to endoscopy showed the following. In patients of groups 1 and 2, there was no recurrence of erosive esophagitis. In patients of group 3 with grade 1 GERD, recurrence of the disease was detected after 3 and 6 months in 44.4% of cases. In patients of group 4, recurrence of the erosive form during endoscopy was detected in 7 patients, which amounted to 87.5%. In patients of the control group, relapse was observed in 100% of cases 6 months after the end of course therapy.

Evaluation of the effectiveness of maintenance therapy according to clinical data

The dynamics of the frequency of heartburn against the background of maintenance therapy in different groups is shown in Figures 1-4.

Picture 1. Dynamics of symptoms in patients of group 1 (Omez 20 mg daily)

Figure 2. Dynamics of symptoms in patients of group 2 (Omez 20 mg every other day)

Figure 3 Dynamics of symptoms in patients of group 3 (Omez 20 mg "on demand")

Figure 4 Dynamics of symptoms in patients of the 4th group (Omez 20 mg on a day off)

The presented data indicate reliable (p * The average price of Pariet, 10 mg, 14 tablets / pack. in Moscow pharmacies was 1074.71 rubles.
** Average price of Omez 20 mg, 30 caps/pack in Moscow pharmacies amounted to 202.4 rubles.

Expenses of a patient with GERD of the 1st degree in outpatient treatment for 12 months. (rubles)

Health care costs for outpatient treatment of a patient with GERD of the 1st degree by a gastroenterologist for 12 months (rubles)

Calculation of the cost of outpatient treatment of one patient with GERD of the 1st degree by a gastroenterologist for 12 months (rubles)

Direct non-medical costs include transportation costs for the patient to travel to the clinic for an appointment with a doctor and for examinations: 5 visits per year - 10 trips (before each doctor's consultation, the patient underwent EGDS on the same day).

When calculating the cost-effectiveness ratio for each group in patients with ERD, the efficiency criterion was the percentage of patients with endoscopic remission of GERD. The calculation results are presented in Table 10.

Cost-effectiveness ratio for maintenance therapy of ERD by groups

Criterion	Group
Criterion	Pariet 1	Pariet 2	Omez 1	Omez 2	Omez 3	Omez 4
Total costs (rub.)	32695,85	10942,06	7142,2	5910,32	5456,05	5650,45
Efficiency (%)	100	100	100	100	55,6	12,5
CEA (rub.)	32695,85	10942,06	7142,2	5910,32	9813,03	45200

From the data obtained, it follows that the least expensive in patients with ERD is maintenance therapy with Omez 20 mg every other day (17.2% cheaper than daily intake of Omez 20 mg, 45.9% cheaper than taking Pariet 10 mg in the "on demand" mode and 81.9% less expensive than therapy with Pariet 10 mg daily) with equal effectiveness.

Maintenance therapy with Omez 20 mg daily is 78.1% cheaper than daily intake of Pariet 10 mg.

When conducting maintenance therapy in patients with ERD in the "on demand" mode, it is advisable to use Pariet 10 mg. Therapy with this drug prevented the occurrence of erosive damage to the esophagus, although it was 10.3% more expensive than therapy with Omez 20 mg.

Reception of Omez 20 mg in the “weekend” regimen is the most expensive: 84.1% more than the daily intake of Omez 20 mg, 86.9% more than the daily intake of Omez 20 mg every other day and 78.2% more than the daily intake of Omez 20 mg in the regimen. "on demand" due to its lowest efficiency.

For maintenance therapy of ERD, it is possible to recommend taking Omez 20 mg every other day, which, with the same effectiveness as both the daily intake of Omez 20 mg and Pariet 10 mg daily and “on demand”, is the least expensive (17.2% cheaper than the daily intake of Omez 20 mg, 45.9% cheaper than Pariet 10 mg on demand and 81.9% less expensive than Pariet 10 mg daily.

In young people, the effectiveness of Omez was higher. The results of evaluating the effectiveness of course and maintenance therapy with Omez at a dose of 1 capsule (20 mg) 2 times a day in 20 patients with GERD stage I-II. at the age of 15 to 25 years (mean age 21.1 ± 0.66 years) showed the following.

Against the background of ongoing course therapy, heartburn decreased by 1 or more points by the 3rd day of treatment in all patients and was completely stopped on 4.4 ± 0.31 days of therapy in 100% of cases. The obtained significant changes were mostly preserved after maintenance therapy. During maintenance therapy with Omez at a dose of 20 mg daily, no relapses of the disease were noted. No side effects were observed.

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A burning sensation behind the sternum, which occurs both on an empty stomach and after eating, is a symptom familiar to many. We are talking about heartburn, which significantly reduces the quality of life. It torments and deprives a person of the joy of eating their favorite dishes. What are its causes, what is esophagitis and is there a place for the drug Omeprazole in the treatment of this disease?

Esophagitis is a chronic disease in which an inflammatory process occurs in the mucosa of the esophagus. It begins in its most superficial layers and gradually penetrates into deeper ones, leading to the development of quite serious complications. This is the most common disease of the esophagus and one of the most common diseases of the digestive system.

In most cases, esophagitis affects men. It can start at a fairly young age - 25-30 years. In every third person, the disease proceeds for a long time without any symptoms, but more often it makes itself felt quite clearly.

Doctors distinguish several approaches to the classification of esophagitis. It can occur suddenly and pass quickly, or it can last for years, while periods of exacerbation and remission will gradually replace each other. The disease is also divided according to the nature of the inflammatory process.

Allocate catarrhal, edematous, erosive, pseudomembranous, hemorrhagic, necrotic and other forms. Esophagitis is also divided for a reason: for some it is the intake of unhealthy food, for others it is smoking and alcohol abuse (with frequent episodes of vomiting), for others it is poisoning with toxic products.

The most common form of esophagitis is gastroesophageal reflux disease. It occurs due to the failure of the sphincter between the esophagus and the stomach, in combination with an increased level of acidity of the gastric juice. The esophagus has a more neutral environment, therefore, when hydrochloric acid is thrown there from the stomach, it has a detrimental effect on the mucous membrane.

Erosion appears over time. Refluxes do not always occur, but when intra-abdominal pressure rises, or a person makes errors in nutrition. In the first case, it is weight lifting, bending, pregnancy, in the second, spicy, fatty, smoked and fried foods.

Esophagitis may go unrecognized for a long time. However, as the disease progresses, a person notes the appearance of heartburn - the leading symptom of this disease. It occurs as a result of the irritating effect of hydrochloric acid on the mucosa of the esophagus, or when food passes through it.

Patients describe a specific burning sensation that appears either directly behind the sternum or deep in the chest. It arises in the epigastric region and rises upward. Sometimes heartburn is accompanied by characteristic sound effects, which are often heard by others.

Patients are very embarrassed by this fact and try to avoid situations where heartburn can hypothetically appear. Signs of esophagitis also include a sour taste in the mouth, increased salivation (hypersalivation), a feeling of pressure, and chest pain.

In acute esophagitis caused by chemical burns, burning food, the clinical picture is more vivid. First of all, the patient is worried about chest pain, sometimes it becomes so strong that pain shock develops. The process of swallowing is disturbed, sometimes up to the complete inability to swallow both solid and liquid food. In the most severe cases, bleeding may occur.

When the first signs of esophagitis appear, it is important to consult a doctor in time. The leading diagnostic method is endoscopic examination of the esophagus. Visually, the doctor can assess the condition of the mucosa, the nature of the inflammatory process, the presence of erosions or ulcers. Once diagnosed, it is important to start treatment promptly.

Antacids are considered the easiest way to stop heartburn. Among them are such well-known ones as Almagel, Phosphalugel, Maalox, Rennie, etc. They allow you to reduce the level of acidity, have a restorative effect on the mucosa of the esophagus, as a result of which they quickly lead to a decrease in discomfort.

These drugs, however, do not affect the course of the disease: after the period of their action, all the unpleasant sensations return. This is due to the fact that the funds do not eliminate the insolvency of the sphincters and do not affect the production of hydrochloric acid by the stomach.

Some patients still use such popular folk remedies as baking soda and milk for heartburn. They do not stand up to scrutiny, because they lead to the production of even more hydrochloric acid after a few minutes.

One of those drugs that really affect the course of the disease and lead to a gradual regression of unpleasant symptoms, that is, they really treat this disease, is Omeprazole. It reduces the production of hydrochloric acid by the parietal cells of the stomach, that is, it reduces the level of acidity in this organ. As a result of this, refluxes occur less frequently, and even if they do occur, the contents of the stomach do not irritate the esophageal mucosa so much.

The drug is available in the form of tablets and solution for intravenous administration. Droppers are used in the acute course of the disease, a serious condition, or when the patient is physically unable to swallow pills. When the patient's condition stabilizes, they are transferred to oral medication, as it is safer, cheaper and not so long. The treatment course is 2 tablets of 10, 20 or 40 mg per day, after which a prophylactic single dose of Omeprazole begins for a long time.

As a rule, treatment with this drug is quite mild. Undesirable side effects develop infrequently. In rare cases, allergic reactions, anemia, headache and dizziness, sleep disturbance or drowsiness, visual impairment, nausea, dyspeptic disorders, elevated liver transaminases, etc. are possible. If they are detected, the doctor transfers the patient to another drug of the same group (proton pump inhibitors) or other acid-lowering drugs.

Despite the fact that Omeprazole is sold in a pharmacy without a prescription, that is, theoretically does not require a medical examination, in reality this should not be. Before use, it is still worth consulting with a specialist, since only a doctor will be able to make an accurate diagnosis and identify possible complications in time.

Heartburn, stomach pain and other unpleasant symptoms - reason to consult with a gastroenterologist. Install the Medical Note app and we will find you the best specialist in this field. It's convenient and free!

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How to treat reflux esophagitis? Reflux disease is not an easy disease, so patients need to be attentive to the appearance of symptoms of this disease and be sure to be examined by a specialist.

Only complex therapy will help get rid of reflux esophagitis, so it will be useful for every person who suffers from this disease to know how this disease should be properly treated with the help of a competent doctor.

Can reflux esophagitis be cured permanently? You can, if you turn to a competent doctor and get modern treatment.

Doctors identify several effective and efficient treatment regimens for reflux esophagitis. All of them are selected strictly on an individual basis for each patient after receiving the results of the examination.

Therapy with one drug. This does not take into account the symptoms of reflux esophagitis, the degree of soft tissue damage, as well as complications. This is the least effective treatment regimen for patients, which can lead to poor health.
Reinforcing therapy. Doctors prescribe different drugs to patients, which differ in the degree of aggressiveness. Patients need to strictly follow a diet and take antacids.
Taking strong proton pump blockers. When the symptoms begin to disappear, patients are prescribed prokinetics. This treatment regimen is suitable for patients diagnosed with severe reflux esophagitis.

Reflux esophagitis: treatment regimen

The classical scheme of treatment of the disease is divided into 4 stages:

First degree reflux esophagitis. Patients should take antacids and prokinetics for a long time (more about taking antacids).
2 degree of the inflammatory process. Patients need to adhere to proper nutrition and take blockers. The latter contribute to the normalization of the level of acidity.
3 degree of the inflammatory process of a severe form. Patients are prescribed the use of receptor blockers, inhibitors and prokinetics.
The last degree of reflux esophagitis is accompanied by pronounced clinical manifestations. Treatment with medicines will not bring a positive result, so patients undergo surgery in combination with a course of maintenance therapy.

How to cure reflux esophagitis permanently? The duration of therapy depends on the degree of damage to the gastrointestinal tract. The initial stage of reflux esophagitis can be cured with a proper and balanced diet. The course of therapy is calculated for each patient individually.

If the process of digestion of food is disturbed, then the contents of the stomach during a long stay in it causes an inflammatory process and irritation of the walls.

Patients feel heaviness in the intestines, a feeling of fullness in the stomach, nausea and bitterness in the mouth. After eating, the pain becomes severe and becomes acute.

There are several effective methods of treating reflux esophagitis, which are prescribed only by the attending physician after diagnosis and study of the patient's history.

How to get rid of reflux esophagitis? Depending on the form of the course of the disease, doctors prescribe patients to take proton pump blockers or H2-histamine receptor inhibitors.

The first group of drugs helps to normalize the work of the glands of the stomach and the mucous membrane of the digestive system.

These medications are prescribed to patients for additional protection of the walls of the esophagus, duodenum and stomach.

With the correct use of blockers, damaged areas of the mucous membrane begin to recover faster. Medicines taken for a long time, and if the patient is diagnosed with a severe form of reflux esophagitis, then they are prescribed a double dosage at the initial stage of treatment.

The most effective drugs include:

esomeprazole;
pantoprazole;
Rabeprazole;
Ranitidine;
Famotidine;
Roxatidine.

These substances help to quickly and effectively cope with the manifestations of heartburn. After using antacids, their main components begin to act on the body after 15 minutes. The main task of such therapy is to reduce the amount of hydrochloric acid, which causes burning and soreness in the chest.

The most effective drugs are:

Gaviscon is an effective and safe new generation alginate.

After taking this remedy, hydrochloric acid is neutralized, an additional layer is formed to protect the stomach and the functioning of the gastrointestinal tract is normalized.

The main task of prokinetics is to improve the motor function of the stomach, muscles and upper small intestine. Physicians advise their patients to use metoclopramide and Domeridon. These medicines will reduce the amount of time the esophagus comes into contact with hydrochloric acid.

Amplipulse therapy has been used for a long time to treat reflux esophagitis.

The procedure is carried out in a physiotherapy room and is aimed at relieving pain, eliminating foci of inflammation, improving gastric motility and blood circulation.

If the patient has severe acute pain, then electrophoresis is performed with ganglioblocking agents. Microwave therapy is indicated for patients who, along with reflux esophagitis, have been diagnosed with pathological disorders in the liver, gastric and duodenal ulcers.

Also, the most effective methods of physiotherapy treatment include applications with sulfide silt mud and electrosleep.

It is important for patients to review the diet and diet. Food should be boiled, steamed or stewed with a minimum amount of oil. An important condition is fractional nutrition in small portions. Patients are not allowed to lie down immediately after eating. Compliance with this rule helps to reduce the intensity and number of attacks at night.

Patients should not overeat, because when the stomach is full, there is an increase in the reflux of contents into the esophagus.

You can learn more about what should be therapeutic nutrition for this disease in this article.

Surgical treatment of reflux esophagitis is carried out in the event that when drug therapy fails. The main goal of surgery is the complete cessation of the reflux of stomach contents into the esophagus. Before the operation, patients undergo a complete comprehensive examination, and only after that a fundoplication is performed.

Access to the stomach can be open or laparoscopic. During surgery, the bottom of the stomach is wrapped around the esophagus to create a cuff. The least traumatic method of the operation is laparoscopic, which has a minimum number of complications.

Treatment of reflux esophagitis with traditional medicine is possible only after consultation with your doctor. It is possible to use collections of plant components only at the initial stage of the development of the disease.

Aloe juice is an effective remedy that envelops the mucosa of the esophagus, reduces inflammation and contact with food.

A decoction of flax seeds acts on the body in a similar way to antacids. After taking such a drug, the level of acidity in the stomach decreases, the esophagus is enveloped and protected.

The main feature of this treatment is proper breathing. This technique is independent or used in combination with physical exercises.

Breathing exercises for reflux esophagitis are performed according to the following scheme:

Patients take a comfortable position for themselves - sitting or standing. Take a deep breath and slowly exhale. A person needs to engage the muscles of the abdominal cavity. The optimal number of such approaches is 4 times.
A calm breath is taken and a quick exhalation by the abdominal muscles (up to 10 approaches).
Patients take a deep breath, hold their breath and squeeze the abdominal muscles strongly. It is necessary to make every effort and pause for up to five seconds. After that, a calm breath is taken.

During breathing exercises, pauses are necessary, because some patients begin to feel dizzy. It is important not to rush and do the exercises consistently. How long reflux esophagitis is treated, so much time and it is recommended to perform these exercises, and in most cases even longer, to ensure the stability of the results.

The following features of gymnastic exercises for reflux esophagitis can be distinguished:

Gymnastics does not help patients get rid of excruciating heartburn. During exercise, the recovery process is accelerated, periods of exacerbation and the number of spasms are reduced.
Each patient will be able to choose for himself the optimal set of gymnastic exercises that will provide real help.
Classes do not belong to the main method of treatment, so they must be combined with drug therapy.

Patients diagnosed with reflux esophagitis can practice yoga. Such exercises bring great benefits to the body and internal organs. Static postures or asanas will fully activate the circulatory system, as well as strengthen the muscle mass of the body.

You can combine static postures with slow movements of the limbs, which will help improve blood circulation in the muscles and internal organs. This unique technique provides patients with the most effective therapeutic effect.

During yoga, all respiratory centers are activated, the saturation of the body with useful oxygen increases, metabolism accelerates, the functioning of internal organs improves, and absolutely all muscle groups are worked out.

Scientists who have studied the physiological characteristics of the body argue that with reflux esophagitis it is best to sleep on the right side.

This will minimize pressure on the stomach, intestines and liver.

To prevent the reflux of food from the stomach into the esophagus at night in patients it is recommended to sleep on a high pillow.

There are several important rules for the treatment of different forms of the disease, which may differ from each other. How long is reflux esophagitis treated depending on this?

The main treatment for patients is to take stomach acid tablets with meals. Such drug therapy helps food move faster into the intestines.

It is important to remember that you can not overdo it with taking pills and take them without a prescription from your doctor, because such an attitude towards your own health can lead to a deterioration in overall well-being. This is due to the fact that the acidic contents of the stomach will not be neutralized with the available amount of bicarbonates.

Gastroesophageal reflux disease (GERD) has become a mass epidemic in the 21st century. Every third inhabitant of developed countries had the misfortune to experience the symptoms of inflammation of the esophagus. Doctors believe that the development of new effective drugs for the treatment of reflux esophagitis is a top priority for modern pharmacology.

Drug treatment of reflux inflammation of the esophagus is aimed at eliminating the cause of the disease, reducing the severity of external manifestations, and recovering the patient.

Successful treatment of GERD with medications requires:

increase the locking ability of the cardiac sphincter;
eliminate motor disorders of the esophagus and stomach;
normalize the acidity of gastric juice;
restore the balance between defense mechanisms and aggressive factors of the esophageal mucosa.

Treatment of reflux with medicines takes place against the background of a change in eating habits, quitting smoking and alcoholic beverages, observing the regime of work and rest.

Medicines for GERD are divided into several main groups:

enveloping agents;
antacids;
proton pump inhibitors (pumps) or PPIs for short;
histamine receptor blockers;
prokinetics;
antibiotics;
enzymes;
healing agents.

Combinations of drugs are selected in accordance with the underlying disease that caused gastroesophageal reflux.

The mucous membrane of the esophagus is constantly irritated and inflamed. The depth of damage to the walls of the esophageal canal depends on the degree of aggressiveness of gastric and intestinal enzymes. Alginates and antacids are capable of protecting the esophageal mucosa. Alginates contain a gel-like substance that creates a barrier to the penetration of hydrochloric acid into the esophagus.

Biogel Laminal is made from processed seaweed, contains alginic acid, iodine, selenium, zinc. Removes toxins, accelerates the healing of the mucosa, relieves pain, enriches the diet with minerals. Apply from GERD for children from 6 years of age in a tablespoon 2 times a day 30 minutes before meals. Adults recommend two tablespoons. The course of treatment is 2 weeks.

Anti-acid drugs for esophagitis neutralize hydrochloric acid in the stomach, reacting with it. Gels, suspensions, chewable tablets contain aluminum, magnesium, calcium salts. New generation products precipitate HCI to insoluble salts that are excreted unchanged from the body. The most effective preparations combine aluminum and magnesium.

In addition to the antacid effect, aluminum salts create a protective film, absorb bile enzymes, increase the tone of the cardiac sphincter. Magnesium salts increase the secretion of protective mucus.

Take symptomatically from attacks of heartburn, not exceeding the indicated dosage. The action of the drugs comes in 5-10 minutes and lasts up to 3 hours.

Treatment of esophagitis is impossible to imagine without proton pump inhibitors. Antacids from this group of drugs disrupt the synthesis of hydrochloric acid at the ionic level, thereby reducing the acidity of the stomach. All proton acid blockers are benzimedazole derivatives.

The main active ingredients are:

Omeprazole - preparations Omez, Promez, Losek.
Pantoprozol - trade names Pantap, Nolpaza, Ulsepan.
Lansoprazole is commercially available under the name Lantarol.
Rabeprazole - contained in the medicines Beret, Razo, Pariet, Rabeprazole.
Esomeprazole - considered the most effective PPI, enters the pharmacy network as Emanera, Nexium, Ezocar, Neo-Zext.

Demanded inhibitor drugs for the treatment of reflux esophagitis in adults are valid for 24 hours. Take once a day before breakfast or after meals. Continue therapy up to 2 months. Together with antibiotics, they can cure gastritis, stomach ulcers - the original causes of reflux.

Long-term uncontrolled PPI therapy is fraught with complications - nausea, headache, stomach polyps, insomnia, kidney failure.

H-2 histamine blockers inhibit the action of histamine. Secretion of HCI occurs in the parietal cells of the gastric mucosa. Secretory cells are located mainly in the fundic region.

Histamine is a mediator in the reaction of synthesis and release of hydrochloric acid. Substances in the composition of histamine blockers are similar in structure to histamine.

They bind to histamine-sensitive receptors, turning them off temporarily.

Medicines from the group of histamine blockers:

Lafutidine;
Cimetidine - analogues of Belomet, Simesan, Histodil, Primamet;
Roxatidine - sold as Roxane;
Ranitidine - contained in the preparations Acilok, Gistak, Zantak, Ranisan;
Famotidine - can be found under the names Gasterogen, Kvamatel, Ulfamid, Famotel.

The release of drugs for esophagitis has been established in solutions for injections and in tablets. Ranitidine is included in the list of vital drugs that relieve allergic manifestations on the lining of the esophagus, promote the healing of shallow mucosal lesions.

Prokinetic drugs and acid blockers play an important role in the treatment of esophagitis. The action of prokinetics is aimed at stimulating the peristalsis of the antrum.

The process of evacuation of the contents of the stomach into the intestine is accelerated, congestion is eliminated, the tone of the esophageal sphincters is increased. The cardiac sphincter is located at the junction of the esophagus to the stomach.

The intensity and frequency of heartburn depends on the tone of his muscles.

Indications for taking prokinetic drugs are nausea after eating, heaviness in the stomach, flatulence, belching, heartburn. All known trade names of prokinetics are based on the substance domperidone.

Pharmacy chains offer medicines:

Used in children from 5 years of age, pregnant and lactating with caution. Possible side effects are dry mouth, thirst, stool disorders, menstrual cycle disorders in women.

Since the late 80s of the last century, antibiotics have been in the lead in the treatment of gastritis, ulcers and their consequences in the form of erosive reflux esophagitis. They fight the cause of erosive mucosal lesions - Helicobacter pylori.

Elimination of a bacterial infection is carried out by the combined effect of penicillins and macrolides. Acid-resistant antibiotics for inflammation of the stomach and esophagus - amoxicillin and clarithromycin. Apply 2 times a day.

The dosage is calculated individually, taking into account age, weight, concomitant diseases. Treat reflux preferably with concomitant use of PPIs with antibiotics.

Reducing the acidity of the stomach accelerates the healing of ulcers and erosions at any stage of tissue damage.

Candidal fungal infection of the esophagus is treated with Nystatin, Ketoconazole, Fluconazole, Clotrimazole, Miconazole. Candidiasis occurs in weakened, elderly people suffering from autoimmune diseases.

Taking antimicrobial agents can lead to antibiotic-associated diarrhea. Violation of the stool occurs from the death of beneficial microflora in the intestine and its settlement with pathogenic microbes - clostridia.

Prevent imbalance of symbiotic flora by prophylactic use of probiotics. The most common probiotics are Linex, Eubicor, Acipol, Enterol, Bifiform.

Pharmaceutical preparations are replaced by products with probiotics - acidophilus, bifilux, kefir, fermented baked milk, sauerkraut.

A decrease in the enzymatic activity of gastric juice leads to a deterioration in the digestive function of the stomach. In this case, congestion, heartburn, belching with an unpleasant odor are observed. For the digestion of food, enzymatic drugs containing pepsin, pancreatin, lipase, amylase, chymotrypsin are prescribed.

The intake of enzymes improves the digestibility of proteins, fats, carbohydrates. Get drugs from the pancreas of animals. Assign Pancreatin, Mezim, Festal, Creon, Penzital after eating 2 tablets.

Non-atrophic superficial gastritis has a chronic course, inflammation affects the upper layer of the mucosa. You can remove the swelling and redness of the mucosa during an exacerbation of the disease with folk remedies. Decoctions of medicinal herbs gently but effectively restore the integrity of the mucous membrane.

Accelerate tissue regeneration, healing erosion and ulcers. The best herbal remedies in the treatment of reflux esophagitis are chamomile, sage, calendula, oak bark, flaxseed. A tablespoon of dry raw materials is brewed with 300 ml of boiling water in a thermos, insisted for 30 minutes. Warm strained broth is taken 100 ml three times a day 20 minutes before meals.

The course of phytotherapy - 2 weeks.

Treatment of inflammation of the esophagus with medicines takes place against the background of a strict diet. Diet rules to follow:

cooking methods - cooking, stewing on water, baking without oil;
food temperature from 30 to 50°C;
the consistency of food - mashed potatoes, soufflés, pates, pureed soups, boiled cereals;
meat - chicken, rabbit, turkey, beef;
fish - cod, hake, pike perch, greenling, pink salmon;
cereals - semolina, rice, oatmeal, buckwheat;
vegetables - potatoes, pumpkin, zucchini, carrots;
fruits - bananas, apples, pears;
milk - boiled low-fat, non-acidic kefir, cottage cheese;
bread - without yeast, yesterday's white, dried;
cookies - dry, lean, without additives;
drinks - herbal tea, rosehip broth, dried fruit compote, mineral table water without gas, jelly.

Diet - even distribution of the daily ration for 5-6 modest meals. It is advisable to eat at the same time. Smoking and drinking alcohol is not allowed. Fried, spicy, fatty, salty, pickled foods, carbonated drinks are excluded.

The mucous membrane of the esophagus and stomach is maximally protected from thermal, chemical, mechanical damage. After eating, you can not bend over, lie down for an hour. Sleep on an elevated headboard.

Reflux esophagitis is treated by reducing acidity, eliminating inflammation, and regulating gastric motility. The drugs are combined to achieve the optimal therapeutic effect. The effectiveness of medicines is increased by diet and the rejection of bad habits. Immunity is strengthened by folk herbal remedies, compliance with the regime of work and rest.

With reflux esophagitis, the tissues of the lower esophagus are damaged by acidic contents thrown from the stomach. This is what explains the unpleasant sensations that disturb a person - discomfort, belching sour, coughing.

Similar symptoms inherent in reflux can provoke a variety of reasons. Therefore, only a specialist should prescribe the optimal treatment tactics - what drugs, their doses, duration of administration.

Conducted medical studies have convincingly shown that in order to cope with reflux esophagitis, treatment with drugs should be combined with other measures - diet therapy, correction of the patient's lifestyle. Only to eliminate the true causes of the disease, you can achieve your goal - to prevent the recurrence of the disease, to eliminate discomfort.

Principles of treatment of reflux esophagitis:

lowering the acidity of the contents of the stomach to acceptable parameters by prescribing appropriate medications;
optimal stimulation of the motility of the structures of the digestive tract - strengthening their evacuation activity;
restoration and protection of the mucous membrane of the esophageal tube with drugs.

The causes and treatment of the disease are closely interconnected - by eliminating the first by the influence of the second, the patient improves his own well-being.

However, it is not recommended to independently purchase in the pharmacy network and take this or that remedy for reflux disorders.

Without knowing the mechanism of pathology formation and the point of application of the pharmacological action of the drug, it is possible to achieve the opposite result - the appearance of severe complications.

The treatment regimen for reflux disease involves taking medication in 2 stages:

healing of existing mucosal defects, relief of inflammatory processes;
restoration of the full activity of the esophageal tube and its natural sphincters.

The first stage requires taking drugs from the anti-inflammatory and anti-ulcer subgroups for at least 6–8 weeks. The duration of pharmacotherapy directly depends on the severity of symptoms and the degree of tissue damage.

At the second stage, the patient takes maintenance doses of medications in order to prevent possible relapse and maximize the restoration of the health of the organ. In severe cases, a person may require lifelong maintenance therapy.

To date, experts have developed several drug treatment regimens for reflux esophagitis, which include drugs with different mechanisms of action and the duration of the desired effect.

The purpose of the use of representatives of this subgroup of pharmaceuticals is the rapid neutralization of hydrochloric acid in the stomach area. In addition, against the background of their use, more bicarbonates are produced, natural defenders of the mucous membrane of digestive structures. They also bind bile pigments and inactivate pepsin.

In most cases, specialists give preference to non-systemic medicines, which contain aluminum or magnesium. Modern antacids:

It is optimal to take them in liquid form, which allows them to be qualitatively distributed over the entire surface of the mucosa.

Antacids are designed specifically to reduce the acidity of gastric contents. The list of contraindications to them is minimal, for example, individual intolerance to active or auxiliary components.

For the production of hydrochloric acid, special cells of the digestive tract are responsible. To reduce their hyperactivity, which is the main cause of the sour belching symptom, it is necessary to take drugs from the subgroup of proton pump inhibitors.

Representatives of this subgroup, for example, Omez, Rabeprazole, Pantoprazole, have the following pharmacological effects:

a significant decrease in the level of basal, as well as stimulated emission of hydrochloric acid;
restoration of the physiological activity of the cells of the gastric mucosa and esophageal tube.

To the undoubted advantages of these drugs, including Omez, experts point out:

rapid onset of the desired effect;
not absorbed into the systemic circulation;
the minimum list of side effects on the patient's body.

Features of the structure of the drug Omez allow you to use it for a long time at the second stage of pharmacotherapy. Symptoms of bitterness in the mouth and discomfort in the epigastric region, characteristic of gastric reflux, due to this, appear much less often.

Effective drugs for esophagitis, which have already managed to prove themselves from the best side both in specialists and in patients, are H2-histamine receptor blockers. Prominent representatives of the subgroup are Ranitidine, Famotidine, Cimetidine, Roxatidine.

Their use has the same goal as proton pump blockers - to effectively reduce the concentration of acid in the digestive juice. They directly affect H2-histamine receptors, prevent their vigorous activity, due to which the production of hydrochloric acid is significantly reduced.

The most effective representatives of this subgroup of medicines are Famotidine and Roxatidine. With their use, there is less likelihood of a withdrawal syndrome.

The undoubted advantages of drugs include:

a rapid decrease in the production of hydrochloric acid in the stomach;
a significant slowdown in the secretion of pepsins;
the possibility of using minimal doses to achieve a therapeutic effect;
stimulation of the own defenses of the gastric mucosa;
improvement of local blood supply to tissues and acceleration of their epithelialization.

With esophagitis in adults, H2-histamine receptor blockers are used quite often. However, the optimal dose and duration of administration should be prescribed only by the attending physician.

Tablets for reflux, the main purpose of which is to enhance antropyloric motor function, are representatives of the subgroup of prokinetics.

Due to the acceleration of the evacuation of the esophageal bolus from the stomach, there is a weakening of the reflux into the esophageal tube.

There is also a pronounced stimulation of the tone of the lower cardia - a muscle ring that normally blocks the entrance to the stomach. The initiation of esophageal self-cleaning is also formed.

Reflux can be cured by:

Cerucal, Raglan - have the ability to enhance the motility and tone of the structures of the gastrointestinal tract, as well as sphincters
Motilium, Domperidone - the absence of systemic effects is indicated as an advantage
Ganaton - the latest generation of prokinetics, helps to accelerate the epithelization of erosions, is effective even with severe inflammation.

How to take prokinetics, their doses and duration of pharmacotherapy should be determined only by a specialist. With a mild course of the disease, it is quite possible to completely cure it.

Effective drugs for the treatment of reflux, of course, are gastroprotectors. Thanks to the timely application, they have a beneficial effect on the tissues of the esophageal tube, as they are able to increase the protective functions of the digestive mucus.

Symptoms of the disease disappear much faster if complex pharmacotherapy contains:

Sometimes the aggravation of the disease occurs due to nervous shocks, psycho-emotional overload. In this case, it is not possible to cope with the problem only with the help of the above medicines. To treat reflux requires specialized help from a psychotherapist.

If the symptoms of reflux of the food bolus are combined with spastic impulses, it is enough to take an antispasmodic, for example, Duspatalin. After elimination of the hyperspasm of the smooth muscles of the intestinal loops, relief of well-being occurs.

If a person prefers homeopathy, it should be taken into account that with its help it is possible to cope only with the initial stage of the disease. In severe cases of reflux, multicomponent pharmacotherapy is necessarily prescribed.

Since reflux esophagitis can be due to various reasons, the therapeutic approach is complex.

It includes dietary and postural therapy, treatment with medications and aids, and surgical correction.

The choice of drug, dosage and duration of its use also depend on many factors. Therefore, it is necessary to take medications after consulting a specialist.

the introduction of restrictions in the diet and the maintenance of a certain lifestyle;
reducing the acidity of the contents of the stomach by prescribing appropriate drugs;
stimulation of the motility of the digestive tract, increased evacuation activity;
the appointment of drugs that provide restoration and protection of the gastric mucosa.

It should be noted that all principles of treatment are closely interconnected. Failure to comply with one of them significantly reduces the effectiveness of therapy.

The duration of the main course of therapy for reflux esophagitis is 4 weeks.

If an erosive form of the disease is observed, then the duration of treatment is increased to 8 weeks, while it is possible to increase the dosage of drugs.

If there are changes outside the esophagus (especially in elderly patients), then therapeutic treatment can last up to 12 weeks. When the effect is achieved, the patient is prescribed maintenance therapy.

It should be noted that in many patients with reflux, the disease is chronic and is accompanied by relapses. In this case, if the symptoms of esophagitis are not observed, then drugs are prescribed as needed.

In the presence of minor and single erosions, the treatment of reflux esophagitis can also last 4 weeks. Otherwise, the duration of treatment is 2 months. Prescribe proton pump inhibitors (morning and evening).

Additionally, the reception of omeprazole, lansoprazole, pantoprazole, esomeprazole is indicated. These drugs are also taken twice a day. The most effective in this case is rabeprozole, which is enough to take once a day.

Even after successful treatment of erosive reflux esophagitis, the vast majority of patients remain at risk of recurrence throughout the year. Such people need long-term therapy with PPIs taken in half doses. The treatment regimen is selected by the doctor, taking into account many individual parameters (age, complications, and others).

If there are no erosions, then the PPI is taken once a day for 4 weeks. The amount of the drug taken depends on the intensity of inflammation and is in the range of 10-40 mg. Without fail, after the main course, maintenance therapy is indicated, the duration of which is determined by the attending physician and can last up to six months.

In the treatment of reflux esophagitis, the following schemes can be used.

The same drug is used. Accompanying symptoms, complications and changes in the mucous membrane are not taken into account. This is an inefficient approach.
It implies diet therapy, taking antacids. Medications are prescribed with varying degrees of exposure, depending on the severity of the inflammatory process.
Effective in the treatment of severe forms of the disease. First, the reception of strong PPIs is shown. After the removal of the inflammatory process, weak prokinetics are prescribed.

The choice of the scheme is carried out by the attending physician based on the clinical picture and examination data.

The classic treatment regimen for reflux esophagitis, presented in 4 stages, depends on the degree of the disease.

As can be seen from the table, the higher the degree of development of the disease, the stronger the drugs.

Drug treatment is carried out in 2 stages. The first is aimed at eliminating provoking factors and ensuring the healing process of the mucous membrane of the organ. At the second stage, the goal of therapy is to achieve remission. In this case, 3 treatment options are possible:

taking PPI for a long time in a high dosage;
as needed, short-term (5 days) intake of PPIs;
the drug is taken only if symptoms appear.

The doctor chooses the necessary option, after agreeing it with the patient.

For drug treatment of reflux esophagitis, different groups of drugs are used, which differ from each other in many factors. They may have a different mechanism of action, the duration of the onset of the effect, vary in time of administration, price, and so on.

Alginates are also designed to reduce the acidity of the stomach contents. They contain alginic acid. These include: sodium alginate, Gaviscon, Topolkan. They are preferred over antacids containing aluminum.

Proton pump inhibitors - PPIs - drugs designed to reduce the acidity of gastric juice by blocking the release of hydrochloric acid by the cells of the body. They have a number of advantages:

fast action;
are not absorbed into the bloodstream;
have a minimum of side effects.

The most common inhibitors are: Rabeprazole, Omeprazole, Pantoprazole, Lansoprazole.

H2-histamine receptor blockers are drugs whose purpose is also to reduce the acidity of gastric juice. They act on H2-histamine receptors, block them, as a result of which the release of hydrochloric acid stops. To date, there are 5 generations of drugs in this group, the most preferred of which are: Ranitidine and Famotidine.

NOTE! A characteristic feature of H2-histamine receptor blockers is to cause a backlash in the event of a sharp cessation of their intake (rebound syndrome).

Prokinetics include drugs that increase the motility of the stomach and its evacuation activity. In addition, they operate in the following areas:

reduce the time of contact of the contents of the body with the inner wall of the esophagus;
contribute to the cleansing of the esophageal mucosa;
increase the tone of the lower esophageal sphincter.

Often, prokinetics are prescribed concomitantly with PPIs. Among them are: Domperidone, Itoprid, Tegaserod.

This group of drugs includes drugs whose action is aimed at increasing the protective properties of the inner wall of the esophagus and stomach. Their use allows:

increase the secretion of mucus and enhance its protective properties;
improve blood circulation in the mucous membrane of the esophagus;
reduce stomach acid (misoprostol);
accelerate the healing of erosions and ulcers on the mucosa of the esophagus and stomach.

Among the drugs can be noted: Dalargin, Misoprostol.

Reflux esophagitis can be caused by another disease or occur with concomitant pathology against its background. In this case, the treatment will be symptomatic:

If the cause is nervous, neurological or psychological problems, then consultation of the appropriate specialist is required. Sedatives, antidepressants, and others may be prescribed.
In the presence of a stomach ulcer, antibiotics are additionally indicated.
If the mucous membrane of the esophagus is exposed to third-party effects on the background of reduced immunity, then it is recommended to take immunostimulating agents in parallel.

According to the same principle, treatment is carried out if any other disorder is a prerequisite for reflux esophagitis.

magnesium phosphate (pain relief);
iris versicolor, veratrumalbum (for heartburn and chest pain);
potassium bichromicum (heartburn, increased secretion of hydrochloric acid);
belladonna, argentumnitricum (severe inflammation, erosion in the esophagus).

Homeopathic remedies are selected in strict accordance with the characteristics of the patient's constitution. Pay special attention to the physical and mental state, the intensity of the disease. At the first stage, symptomatic drugs are selected, and then, as the condition improves, the main drugs are prescribed, usually in high dosages (no more than three drugs).

To accelerate tissue regeneration, restore general and local immunity and ensure a speedy recovery, vitamins and macro- and microelements are needed. The usual diet does not provide sufficient intake of these compounds in the body, especially in diseases of the digestive tract. Therefore, you also need to take multivitamin complexes.

To date, there are various approaches to the medical treatment of reflux esophagitis. The choice of either method is determined by the severity of the disease, morphological changes in the esophageal tissue, secretion features and other factors:

According to Sheptulin. The essence of the approach: the appointment of drugs of varying degrees of aggressiveness in several stages.

Combination of antacids with diet therapy and lifestyle changes.
Use of prokinetics or blockers of H2-histamine receptors.
The use of proton pump inhibitors or H2-histamine receptor blockers in conjunction with prokinetics.

According to Grigoriev Therapy is based on the stage of the disease and its form.

At the initial stage of development of reflux esophagitis, diet therapy is indicated in combination with antacids. The latter can be replaced with a short course of H2-histamine receptor blockers.
In the second degree, a long course of prokinetics and H2 blockers is prescribed. A short course of treatment with proton pump inhibitors is possible.
In the third stage of the disease, H2 blockers are combined with PPIs. Another option: prokinetics and blockers in high dosages.

If the effect of drug therapy is absent, then surgical intervention is indicated. In the event of a deterioration in the psychological state of the patient, Eglonin or Grandaxin with Teralen are prescribed.

The tasks of maintenance therapy include reducing the aggressive effects of drugs. In the first two stages of the disease, this function is performed by prokinetics in the usual dosage. With a more severe course of reflux esophagitis, strong H2-blockers are added to the prokinetics. Admission is permanent, under diagnostic control of the state of the mucous membrane.

During pregnancy, the appointment of high doses of antacids with aluminum, as well as sodium bicarbonate, is contraindicated. Taking antacids with magnesium will result in a mild laxative effect. For treatment, you can use such medicinal and herbal remedies as:

chamomile flowers;
alginates;
starch;
alder seedlings.

The greatest effect is achieved with a combination of alginates and astringents.

Drug therapy of reflux esophagitis in children should be carried out only under the supervision of a physician. The diagnosis is made after a thorough examination.

With a mild degree of the disease, antacids or H2-histamine receptor blockers (Ranitidine, Famotidine) are most often prescribed.

When used independently, it must be remembered that these remedies eliminate only the symptoms of the disease, and not the cause.

In infants, reflux is a normal physiological phenomenon, but its course also requires special attention.

In the event of its transition to a pathological form, urgent measures will need to be taken to prevent the further development of the disease.

Treatment of reflux esophagitis in infants is not schematized, as it is performed only according to strict indications and in accordance with a specific case. Basically, postural therapy, antireflux mixtures, correction of diet are used.

For older children, as well as for infants, the treatment of reflux esophagitis begins with a change in diet, diet therapy, and the use of herbal decoctions. If non-drug therapy does not lead to relief of the condition, then drugs are used. At an older age, according to the testimony of a doctor, it is possible to use drugs such as:

antacids and alginates;
blockers of H2-histamine receptors.

The main drugs for treatment in this case are antacids. If the symptoms of reflux esophagitis in a child appear regularly, then the use of PPIs and blockers is additionally indicated.

ATTENTION! The choice of the drug, its dosage and the duration of the course of treatment is carried out only by a doctor!

Treatment of reflux esophagitis is a long process that requires a medical stage. If the drugs and the treatment regimen are chosen correctly, then this contributes to a faster recovery and prevention of relapses.

Otherwise, the disease may take a chronic form and / or go to the next stage. Therefore, it is very important to contact a specialist in time and follow his instructions in a timely manner.

To date, there is a sufficient number of medications and methods that allow you to get rid of pathology at any age.

Dosage forms and composition of the drug

The active ingredient is omeprazole. The substance dissolves exclusively in the intestine. The required concentration is reached after half an hour or an hour.

There are several types of forms of release of this drug:

enteric capsules;
Powder for suspension;
Solution in ampoules for injections.

Capsules can contain 10, 20, 40 milligrams of the active substance and dissolve easily in the intestines.

One vial of injection solution contains 40 milligrams of Omeprazole.

In the treatment of various diseases of the gastrointestinal tract, an integrated approach is possible.

Omez interacts with other drugs in different ways:

The simultaneous use of Omez and De-Nol is allowed with the appointment of the attending physician
With De-nol. The simultaneous use of these two drugs is allowed with the appointment of the attending physician. Sometimes they are part of the same treatment regimen;
with diclofenac. It is possible to combine medications. Omez is able to protect the stomach from the harmful effects of diclofenac on it;
Omez is compatible with the drug Concor;
Allowed to receive Salofalk and Omez at the same time;
Simultaneous application Omeza and Trimedata will not bring any complications;

Omez is often prescribed by doctors when taking antibiotics. This is necessary to protect the stomach from the negative effects of antibacterial agents on the stomach.

What are esophagitis

Erosion appears over time. Refluxes do not always occur, but when intra-abdominal pressure rises, or a person makes errors in nutrition. In the first case, it is weight lifting, bending, pregnancy, in the second, spicy, fatty, smoked and fried foods.

Interaction with other drugs

This drug is intended to suppress secretion in the stomach. Antiulcer action. The degree of basal secretion decreases with any stimulus. Omez has an effect an hour after ingestion, is able to remain in the body throughout the day.

Maximum effect after two hours. When the drug is finished, secretion activity will be restored after four days.

This medicine contains domperidone. The substance has an antiemetic effect, improves the rate of gastric emptying.

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How to suspect esophagitis

Esophagitis may go unrecognized for a long time. However, as the disease progresses, a person notes the appearance of heartburn - the leading symptom of this disease. It occurs as a result of the irritating effect of hydrochloric acid on the mucosa of the esophagus, or when food passes through it.

Best Heartburn Remedies

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Contraindications of the drug

This drug is prescribed only by a specialist for gastrointestinal ailments.

Omez is issued after special examinations:

Required tests;
Diagnostics using equipment.

The medication is prescribed for the following diseases:

peptic ulcer, exacerbation of gastric ulcer and duodenal ulcer;
Gastric ulcers against the background of severe stress;
Erosive and ulcerative esophagitis;
Peptic ulcers resulting from taking a course of non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs);
Zollinger-Ellison syndrome;
Erosive and ulcerative disorders of the gastrointestinal tract. There is an ailment due to cirrhosis of the liver;
Reflux esophagus.

The drug is used in some cases of pancreatitis.

This drug is prescribed by a gastroenterologist to be taken in combination. It contains: Omeprazole, as well as Domperidone.

The medicine has the following indications:

Dyspepsia. Reception is possible when heartburn is added to the disease;
Erosive and ulcerative esophagitis.

Provides the following actions:

Capable minimize nausea, remove the gag reflex;
The sphincter of the esophagus is activated in its tone;
Makes bowel movements faster. Peristalsis increases;
Digestion begins to work more efficiently.

The instruction provides information on the following contraindications:

lactation period;
Pregnancy;
Childhood;
Individual intolerance to the active ingredient;
Obstruction of the stomach or intestines;
Bleeding in the stomach or intestines;
Perforation of the intestine, stomach;
A brain tumor.

Hypersensitivity to the components of the drug is extremely rare.

Caution should be taken when taking Omez for those who have liver failure or kidney problems.

If there are any suspicious symptoms (sudden weight loss, regular vomiting with blood impurities, and others), including with a stomach ulcer, you should make sure that there is no malignant tumor.

For this reason, an endoscopic examination is prescribed before taking the drug. It is necessary so that the symptoms are not hidden, thereby hiding the true diagnosis and delaying treatment.

The instructions do not prescribe the prohibition of the joint use of the drug and alcohol. Omez does not affect what is contained in the stomach.

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How to treat esophagitis

Does gastroscopy hurt?

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Antacids are considered the easiest way to stop heartburn. Among them are such well-known ones as Almagel, Phosphalugel, Maalox, Rennie, etc. They allow you to reduce the level of acidity, have a restorative effect on the mucosa of the esophagus, as a result of which they quickly lead to a decrease in discomfort.

The drug is available in the form of tablets and solution for intravenous administration. Droppers are used in the acute course of the disease, a serious condition, or when the patient is physically unable to swallow pills. When the patient's condition stabilizes, they are transferred to oral medication, as it is safer, cheaper and not so long.

Heartburn, stomach pain and other unpleasant symptoms are a reason to consult a gastroenterologist. Install the Medical Note app and we will find you the best specialist in this field. It's convenient and free!

Can children take

There are exceptional cases in which the doctor prescribes this drug to children, reducing the dosage by half. Still, you should not take risks, because the instructions contain a contraindication for children under the age of eighteen.

It is better to replace Omez with a diet or similar analogues of the drug that are safer for the child (Almagel, Famotidine).

Dosage of Omez

The dosage and duration of administration varies depending on the diagnosis made by the doctor:

Often intravenously required
Zollinger-Ellison disease requires three doses during the day, one tablet. In some cases, there is a need to increase the dosage.
With exacerbation of duodenal ulcer the medication should be taken one tablet per day. The duration of treatment is a month.
In case of exacerbation of gastric ulcer, as well as with erosive and ulcerative digestive disorders that have arisen as a result of taking nonsteroidal drugs, a long course of treatment is required, about several months, more often two months.

You need to take the capsules twice a day. It is often required to administer the drug intravenously (forty ml during the day).

Capsules are taken orally. You need to drink clean non-carbonated water (you can not chew a tablet), half an hour before meals.

Instructions for use:

During the period of exacerbation of the ulcer, as well as with reflux esophagitis, it is taken 20 milligrams twice a day - in the morning and in the evening. Treatment should last up to three weeks, if necessary - five weeks.
For the treatment of Zollinger-Ellison disease you need to take 60 milligrams of the drug.
Preventive measures against Mendelssohn's syndrome- capsules of 40 milligrams at least one hour before surgery.
To prevent relapse gastric and intestinal ulcers should be taken 20 milligrams once a day.
With liver failure- take 20 milligrams per day;
With pancreatitis, 120 milligrams is prescribed. Three times a day. The course of treatment may be different. From a couple of weeks to a month;
To get rid of Helicobacter- 40 milligrams twice a day; Two weeks duration;
With gastritis with an increase in the level of acidity You need to take one tablet per day. It is recommended to take the tablet on an empty stomach. Continue treatment for two months.

If intravenous administration is prescribed by a doctor, it should be taken from 40 milligrams to 70 during the day.

In case of an overdose, unpleasant, discomforting symptoms are possible. Visual impairment, dry mouth, headache, sleep disturbances.

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Side effects when taking the drug

The drug has a rather impressive list of unpleasant side effects that are possible after ingestion or intravenous ingestion. They happen very rarely, disappear immediately after the cessation of use.

Most often, allergic manifestations in the form of a rash or urticaria were noticed. Omez is approved for purchase at a pharmacy without a prescription from a specialist.

The instructions list the following side effects:

Chair problems. Everyone may experience unpleasant symptoms in different ways. The drug can cause severe diarrhea, encourage frequent bowel movements. It can also cause complete absence of stools and constipation;
Pain, bloating, heaviness in the abdomen;
Severe nausea, rarely vomiting;
flatulence, strong flatulence;
Violations in the liver;
Changed taste in the food taken by the sick;
Functions of a liver are broken. In some cases, icteric hepatitis is possible;
Stomatitis;
Dryness in the mouth;
Blood disorders. Rarely - leukemia;
People who are subject to severe emotional stress, with a weak nervous system, may be subject to mental health problems. There is a possibility of depression, excessive excitability, aggressiveness, nervousness, breakdowns;
Patients with a diseased liver are susceptible to hepatic encephalopathy;
General weakness of the body, malaise;
visual impairment;
Hair loss;
Allergic reactions. Severe itching, redness on the skin and other manifestations of allergies;
Possible swelling of the body;
increased sweating;
Cysts in the stomach.

These side effects are extremely rare. If they appear, you should take a doctor's consultation and change this medicine to another.

With a slight manifestation of undesirable effects, it is possible to alleviate them and relieve symptoms. The doctor may reduce the dosage or replace with similar drugs.

In case of allergic reactions to the funds, you must immediately stop taking the capsules.

Conditions and terms of storage of the drug

This medication is approved for sale without presenting a prescription from a doctor to the pharmacist. It should be stored in a very dry, not bright place and be inaccessible to children.

The price of the drug Omez

The price of the tool is quite affordable. You can buy it both in a regular pharmacy and in an online store.

The price varies depending on the dosage, concentration, the number of tablets inside and the type of drug:

Capsules of 10 milligrams - about 100 rubles(30 pieces);
Thirty capsules of 20 milligrams cost about 200 rubles;
Omez D. Thirty capsules - approximately 250 and more rubles;
Omez Insta. In the amount of five pieces. Can be purchased for 80 rubles;

You can find out the exact price directly in your city at the pharmacy.

Drug analogues

The drug has analogues and Russian production and foreign. Do not choose an analogue without the advice of a specialist.

There are the following substitutes for Omez:

Omeprazole;
Nolpaza;
Omecaps;
Gastrozole;
Demeprazole;
Ultop;
Crismel;
Omezol;
Ranitidine;
Orantol;
De Nol.

Ultop
Ornatol

Ranitidine
Omeprazole

Nolpaza
Gastrosol

Omezol
Demeprazole

De-Nol

Prices for these medicines will vary depending on who makes the remedy.

Omez and Nolpaza

The effect of these drugs is approximately the same. Both of these help the body reduce hydrochloric acid levels. They also reduce symptoms in case of serious ailments of the gastrointestinal tract.

Nolpaza contains an active substance. It's called Pantoprazole. The advantage of Nolpaza is that the effect of this remedy on the body sometimes occurs more quickly than that of Omez.

Omeprazole

The therapeutic effect is similar. The difference between the analogue and the original is only in the additional components. The manufacturer is also different. The analogue has the maximum content of the active ingredient.

In Omez, it is much less, but thanks to its additional substances, the likelihood of side effects is minimized.

Omeprazole has a more affordable and low price.

De Nol

This is an anti-ulcer drug. Works in the same way as Omez. The difference is the presence of bismuth subcitrate.

Conclusion

The drug Omez must be started to useonly if prescribed by a specialist gastroenterologist. You should undergo a medical examination, such as a gastroscopy, to detect pathologies or diseases of the gastrointestinal tract. Also, in order to exclude those disorders that the drug can aggravate.
Omez has a fairly large amountunwanted side effects Therefore, it is recommended to approach its use with great care and seriousness.
The medicine is intended for the treatment of various disorders of the gastrointestinal tract. Do not start taking children under the age of 13 and women during pregnancy or breastfeeding. A child who is not yet eighteen years old can only be prescribed treatment with Omez by a doctor in special cases when other methods of treatment cannot be dispensed with.
When side effects occur it is recommended to immediately consult a doctor so that he changes the treatment or replaces the remedy with a similar one.

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

The drug Omeprazole

A drug Omeprazole refers to the most modern antisecretory drugs used in the treatment of peptic ulcer and erosive and inflammatory diseases of the upper gastrointestinal tract. Mechanism of action refers to proton pump inhibitors.

Omeprazole inhibits the production of hydrochloric acid in the stomach and reduces its activity. This drug acquires its medicinal properties only after it enters an acidic environment, which is just characteristic of the stomach.

After ingestion, the drug actively penetrates into the special cells of the stomach that are responsible for the secretion of hydrochloric acid. In them, it accumulates and, thus, regulates the production of gastric juice and pepsin (an enzyme that breaks down proteins).

Omeprazole has a bactericidal effect on the main "culprit" of gastritis and peptic ulcer - the microorganism Helicobacter pylori (Helicobacter pylori). That is why Omeprazole is mandatory included in the list of drugs that suppress Helicobacter pylori infection in gastric and duodenal ulcers.

With pathological reflux of gastric contents into the esophagus (reflux ulcerative and erosive esophagitis), the mucous membrane is inevitably damaged, and ulcerative defects are formed on it. Omeprazole, taken orally, is able to reduce the damaging effect of hydrochloric acid, restore the pH of gastric juice and significantly reduce the severity of the main symptoms of the disease.

Omeprazole not only significantly improves the well-being of patients, but also leads to a sharp decrease in the likelihood of the disease returning and the development of its complications. Its action begins within 1 hour after ingestion and continues throughout the day. Omeprazole reaches the therapeutic maximum after 2 hours. The higher the dose of the drug, the stronger the inhibitory effect on the parietal (hydrochloric acid-producing) cells of the stomach.

Omeprazole is excreted from the body through the kidneys (up to 80%) and intestines (about 20%). In the elderly, as well as in chronic renal failure, the elimination of the drug from the body may be slowed down.

Release forms

In the pharmacy network, the drug Omeprazole is sold in tablets, capsules and solutions for intravenous administration.
1. Enteric capsules contain 10 mg or 20 mg of the main active ingredient - omeprazole (7 capsules in a blister pack, there can be from 1 to 4 blister plates in a pack); some manufacturers pack capsules in polymer jars of 30 or 40 pieces;
2. MAPS tablets (pellets), coated with 10 mg, 20 mg or 40 mg of the active substance (No. 7, 14, 28);
3. Powder for infusion solutions in 40 mg vials (5 vials per pack).

The drug is issued only by prescription.

Instructions for use Omeprazole

Indications for use

Omeprazole has a wide range of indications for diseases of the upper gastrointestinal tract. The drug is usually prescribed to adults and children over 5 years of age in the following cases:
1. In the complex treatment of the active phase of gastric ulcer and duodenal ulcer associated with Helicobacter pylori infection;
2. For the treatment of Zollinger-Ellison syndrome;
3. To stop the manifestations of gastroesophageal reflux (reflux of gastric contents into the lower part of the esophagus);
4. To eliminate uncomplicated heartburn, which lasts more than 2 days during the week;
5. As a course treatment of endoscopically confirmed erosive esophagitis;
6. For the correction of hypersecretory disorders in the upper digestive tract;
7. For the treatment of gastropathy, which was formed from the use of non-steroidal anti-inflammatory drugs;
8. In the combined treatment of polyendocrine adenomatosis;
9. Prophylactically, to prevent recurrence in chronic duodenal ulcers, aspirin and stress ulcers.

Contraindications

The main contraindication for taking Omeprazole is intolerance to any of the components of the drug.

In addition, the drug is not recommended during pregnancy. It has been clinically proven that taking omeprazole, especially in the first trimester of pregnancy, can lead to fetal malformations. Therefore, the drug is prescribed only in extreme cases, when the benefits of its use far outweigh the side effects.

The drug penetrates well and quickly into the blood and breast milk, so it is not prescribed during lactation.

Omeprazole helps to reduce the acidity of gastric juice, in this regard, it is not prescribed for gastritis with low acidity, atrophic gastritis.

Omeprazole is also contraindicated in patients with suspected oncological pathology of the stomach or duodenum. In this case, the drug can level the existing symptoms and make it difficult to make a final diagnosis. There is evidence that omeprazole in this pathology can stimulate the growth of an existing neoplasm.

Other contraindications include osteoporosis and a tendency to spontaneous bone fractures. Omeprazole leaches calcium from the bones, so it can increase the effects of osteoporosis. In case of emergency, treatment with omeprazole under the cover of calcium and vitamin D preparations is allowed.

Before prescribing Omeprazole, it is necessary to make sure that the patient does not have the following conditions:

Malignant tumors of the digestive tract;
Gastrointestinal infections - salmonella, compylobacter, because. Omeprazole can enhance their reproduction;
Liver failure - in this case, the biotransformation of the drug slows down sharply and toxic inflammation of the liver cells occurs;
Renal failure slows down the excretion of the drug from the body.

Side effects

Side effects from taking omeprazole are quite rare. As a rule, they occur with improper or prolonged use of the drug (more than 2-3 months in a row). In these cases, digestive disorders are most often observed - nausea, bloating and abdominal pain, diarrhea or constipation. Some patients complain of headaches and dizziness. All symptoms usually go away on their own after discontinuation of the drug.
In addition, omeprazole can cause:

Violation of taste sensations, dryness and inflammation of the oral mucosa.
Nausea, vomiting, loose stools, flatulence.
Impaired liver function.
Nervous system disorders (in patients with severe comorbidities) - depression, irritability, headache, lethargy, weakness, sometimes encephalopathy.
Skin rashes, itching, redness and peeling, exudative erythema, increased sensitivity to light, local alopecia.
Allergic reactions in the form of fever, urticaria, angioedema, bronchial muscle spasm, interstitial nephritis; in very rare cases - anaphylactic shock.
Change in the qualitative and quantitative composition of the blood - a decrease in the number of leukocytes, platelets; sometimes B12-folate deficiency anemia develops.
Sometimes pain in large joints and muscles is observed, and muscle weakness develops.

Extremely rare side effects are enlargement and engorgement of the mammary glands, decreased visual acuity, swelling in the lower extremities, the formation of glandular cysts in the stomach, which are benign and reversible.

Treatment with omeprazole

Due to the fact that improper or uncontrolled administration of the drug can cause serious harm to the gastrointestinal tract, only a doctor can prescribe it.

How to take Omeprazole?
Omeprazole should be taken immediately before meals or during breakfast. If repeated administration of the drug during the day is necessary, it is usually prescribed in the evening.

Capsules should not be chewed or divided into parts. The required dose of the drug is washed down with a small amount of clean non-carbonated water.

If Omeprazole tablets (pellets) are used as a remedy, they can be dissolved in acidified water, yogurt or juice (15-20 ml). The diluted drug should be drunk within 30 minutes.

Dosage of Omeprazole
The standard single dose of the drug is 20 mg, but it can be adjusted by the doctor depending on the severity of the disease and the general condition of the patient. Omeprazole is prescribed in courses of no more than 2 months, after which a break for several months is necessary.

With gastric ulcer in the acute stage, Omeprazole is prescribed 20-40 mg per day, the dose is divided into 2 doses. The course of treatment is from 1 to 2 months.
With erosive-ulcerative esophagitis, treatment is prescribed similarly to gastric ulcer. As an anti-relapse treatment, omeprazole 20 mg per day is prescribed. The duration of treatment can be from 1 to 2 months.
At duodenal ulcers the daily dose of the drug is 20 mg, the course of treatment is 2-4 weeks. To prevent recurrence of the disease, maintenance doses of omeprazole are prescribed for up to 4 weeks. In this case, it is necessary to use capsules containing 10 mg of the main active ingredient.
At gastropathy and erosive and ulcerative lesions caused by taking non-steroidal anti-inflammatory drugs, 1 capsule of Omeprazole is prescribed per day for a period of 4 to 8 weeks.
For treatment Zollinger-Ellison syndrome the dose of Omeprazole is selected strictly individually, depending on the initial level of secretory activity of the stomach. The minimum daily dose is 60 mg. In the future, the dose can be increased to 120 mg / day, while the amount of the drug is divided into 2 doses - in the morning and in the evening.
For treatment Helicobacter pylori infection take 20 mg of the drug in the morning and evening, the minimum course is 7 days. Omeprazole in such treatment is always taken in a single block with antibacterial agents, according to one of the existing schemes (triple or quadruple therapy).
For cupping uncomplicated heartburn 20 mg of omeprazole is prescribed once a day for 14 days. A second course of treatment is possible after 4 months.
In patients with concomitant liver diseases, the daily dose of the drug should not exceed 20 mg.
For prevention leakage of acidic stomach contents into the esophagus during long-term operations, omeprazole is prescribed 40 mg the day before and 2-4 hours before the operation.

In a serious condition of the patient, especially if he is in the intensive care unit, omeprazole can be administered through a catheter directly into the stomach, or sterile solutions for intravenous infusion can be used. For administration through a catheter, dilute 20 mg of powder from a capsule in 30 ml of water, insist for 3-5 minutes and inject through a gastric tube. For intravenous drip, 40 mg of sterile Omeprazole powder (1 vial) is diluted in 100 ml of 0.9% sodium chloride solution or 5% glucose.

Omeprazole for children

Children under 5 years of age, the drug is usually not prescribed. However, for Zollinger-Ellison syndrome and some other acute diseases of the upper digestive tract, the doctor may prescribe omeprazole. In this case, the dose of the drug is calculated based on the body weight of the child.
1. With a body weight of up to 10 kg, the drug is prescribed 5 mg per day.
2. With a weight of 10 to 20 kg, the daily dose of the drug is 10 mg.
3. With a child weighing 20 kg or more, a single dose of 20 mg of omeprazole per day is allowed.

Omeprazole during pregnancy

Pregnancy is a contraindication for the appointment of omeprazole. It is especially important to avoid taking the drug in the first trimester of pregnancy, because. in this case, the risk of developing a pathology of the cardiovascular system in the fetus increases sharply. At other stages of pregnancy, omeprazole is prescribed with great care and only if the positive effects of the drug outweigh the possible side effects.

Omeprazole for gastritis

Omeprazole is prescribed only for gastritis with high acidity! With normal and hypoacid gastritis, omeprazole is contraindicated and can provoke the development of atrophic gastritis with zero acidity of gastric juice.

The maximum effect of a single dose of omeprazole at a dose of 20 mg occurs on average after 1.5-2 hours. The therapeutic effect of the drug lasts from 18 to 24 hours, therefore, with gastritis, the daily dose of Omeprazole is 1 capsule (20 mg). The duration of treatment usually does not exceed 2-3 weeks. During this time, the acidity of the stomach is normalized and the main symptoms of gastritis are eliminated.

If gastritis is associated with Helicobacter pylori infection, then along with Omeprazole, it is necessary to carry out mandatory antibacterial treatment according to one of the generally accepted schemes in this case (triple therapy).

Omeprazole for heartburn

Omeprazole effectively eliminates the symptoms of heartburn in various diseases of the gastrointestinal tract. However, its independent reception is allowed only as an exception, as a means of ambulance. Its dose in this case should not exceed 10 mg per day. The therapeutic effect of Omeprazole develops after 4-5 days, and the full course of treatment should not exceed 14 days. It is possible to repeat treatment with Omeprazole not earlier than after 4 months.

If at the end of treatment heartburn returns, it is necessary to consult a doctor for advice and examination. The same should be done with frequently recurring heartburn, especially if they occur more than 2 days a week. In this case, appropriate treatment with Omeprazole in appropriate dosages will be prescribed.

Interaction of Omeprazole with other drugs

Omeprazole can change the effect of any drug (Ketoconazole, Itraconazole, Ampicillin, iron salts, etc.), the activity and absorption of which depends on the pH of the stomach.

Drugs that are transformed in the liver (Warfarin, Diazepam, Phenytoin, etc.) may, when interacting with Omeprazole, break down more slowly, increasing their concentration in the blood and tissues. Omeprazole also slows down the release of tranquilizers from the body (Sibazon, Diazepam, Elenium). In these cases, it may be necessary to reduce the dose of these drugs.

Omeprazole may enhance the effect of indirect anticoagulants and anticonvulsants (coumarins, Difenin). With the simultaneous administration of Clarithromycin and Omeprazole, the effects are mutually enhanced.

Omeprazole enhances the negative effect on the hematopoietic system of other medicinal substances.

Omeprazole's analogs

Due to its popularity and high efficiency, Omeprazole has many analogues and generic drugs (synonyms) that contain the same main active ingredient, but differ significantly in price.

The most popular analogues (synonyms) that are allowed in Russia:

Bioprazol;
Gastrozole;
Omez;
Omephez;
Ulzol;
Omezol;
Omeprazole-Acre;
Omeprazole-Richter;
Losek;
Losek Maps (pellets);
Gasek.

There are also other analogues of Omeprazole that are not registered in the Russian Federation:

Gasek (Switzerland);
Omeprazole-Astrapharm (Ukraine);
Omeprazole-Darnitsa;
Cerol (India).

Antra MUPS, Prilosec, Lokit, Proseptin, Romesek are widely used in the European pharmacy market.

Reviews about the drug

Lena, Novokamsk:
“After giving birth, I often began to experience heartburn and nausea. I thought that this was a temporary phenomenon associated with the restructuring of the body, but time passed, and my condition only worsened. I went to the doctor for an examination and it turned out that I had GERD, biliary dyskinesia and duodenitis... Among other things, the doctor prescribed me Omeprazole. It helps me very quickly, literally removes heartburn in a matter of minutes, and after 3-4 days almost all symptoms disappear. I tried to drink other drugs - Lasek and Omefez, but only our domestic Omeprazole. Only he helps me best and does not give any side effects. "

Victoria, Nizhnevartovsk:
“I had stomach problems since school, and when I went to study at the institute, it got even worse. Stomach pain, nausea, eternal heartburn, problems with stools, naturally, problems with hair and skin ... After another exacerbation, I turned to to a paid clinic, where a gastroenterologist prescribed a course of Helicobacter pylori treatment for me. I drank antibiotics (amoxicillin and clarithromycin) and Omeprazole. The course of treatment was 4 weeks. As a result, I am very pleased with the results of the treatment, all the symptoms disappeared, Helicobacter pylori was no longer found in me. Thank you the doctor who advised me this treatment regimen."

Pavel, Volgograd:
“I have such a job that I really don’t have time to eat during the day. As a result, I got myself gastritis with high acidity and some other kind of reflux. I felt better. When I felt really bad, I went to the local doctor, she sent me for examinations, and then prescribed Omeprazole in capsules of 20 mg. I drank a capsule twice a day. About a week later I felt much better, and at the end of treatment, t .e. after 2 months, I completely forgot about my sores. Once every six months I go through prophylactic treatment with Omeprazole so that this reflux does not return and everything is fine, alive, healthy!"

Where to buy Omeprazole?

Given that Omeprazole 20 mg is a prescription drug, it can only be purchased at the pharmacy network.

But even in the case when Omeprazole is used in an over-the-counter dosage (10 mg in 1 capsule), it should be purchased only at licensed points of sale - in stationary or online pharmacies. For example, on the Internet, you can order Omeprazole on the Piluli.ru website, in the WER.RU wholesale price web pharmacy, and in the IFC pharmacy. These pharmacies always have this drug in stock and operate throughout Russia.

The price of the drug

The price of Russian-made Omeprazole is low and available to any patient. So, Omeprazole in capsules of 20 mg, 14 pieces, costs 11-12 rubles on average, 28 capsules are sold for 16-20 rubles. The maximum price for domestic Omeprazole rarely exceeds 60 rubles per pack.

However, it must be remembered that the price varies not only depending on the number of capsules or tablets in the package, but also strongly depends on the recognition of the manufacturer.

For example, the Indian analogue of Omeprazole - Omez 20 mg, 10 capsules costs from 65 rubles, and for the Indian Omez D in N30 capsules you need to pay 244 rubles. European analogues of Losek Maps have a significantly higher cost - from 300 rubles and more. For drugs from some manufacturers, you will have to pay from 1000 to 1500 rubles per package, which is usually enough for the entire course of treatment.

The intermediate cost for the drug has analogues produced in the former socialist countries. Slovenian Omeprazole Sandoz 20 mg costs about 95 rubles for a pack of 14 capsules, and for 28 capsules you need to pay about 140-150 rubles. Czech Helicide - 28 pieces / 20 mg costs approximately 180 rubles.

Which of these drugs to give preference, the doctor must decide. Only he knows all the features of the action of Omeprazole and its analogues, therefore, he can prescribe the most adequate drug that will affect the maximum number of existing symptoms.

Before use, you should consult with a specialist.