Long-term omeprazole treatment in resistant gastroesophageal reflux disease: efficacy, safety, and influence on gastric mucosa

Gastroenterology. 2000 Apr;118(4):661-9. doi: 10.1016/s0016-5085(00)70135-1.


Background & aims: The efficacy and safety of long-term acid suppression remains a subject for debate. We report data from patients with refractory reflux esophagitis who were undergoing maintenance therapy with >/=20 mg omeprazole daily for a mean period of 6.5 years (range, 1.4-11.2 years).

Methods: Patients with severe reflux esophagitis resistant to long-term therapy with H(2)-receptor antagonists and who were not eligible for surgery were evaluated at least annually for endoscopic relapse and histological changes in the gastric corpus.

Results: In 230 patients (mean age, 63 years at entry; 36% were >/=70 years), there were 158 relapses of esophagitis during 1490 treatment years (1 per 9.4 years), with no significant difference in relapse rates between Helicobacter pylori-positive and -negative patients. All patients rehealed during continued therapy with omeprazole at the same or higher dose. The annual incidence of gastric corpus mucosal atrophy was 4.7% and 0.7% in H. pylori-positive and -negative patients, respectively, which was mainly observed in elderly patients who had moderate/severe gastritis at entry. In patients with baseline moderate/severe gastritis, the incidences were similar: 7.9% and 8.4%, respectively. Corpus intestinal metaplasia was rare, and no dysplasia or neoplasms were observed. The adverse event profile was as might be expected from this elderly group of patients.

Conclusions: Long-term omeprazole therapy (up to 11 years) is highly effective and safe for control of reflux esophagitis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Ulcer Agents / adverse effects
  • Anti-Ulcer Agents / therapeutic use*
  • Barrett Esophagus / etiology
  • Child
  • Drug Resistance
  • Esophagitis / drug therapy
  • Esophagitis / etiology
  • Female
  • Gastric Mucosa / drug effects*
  • Gastrins / blood
  • Gastritis / etiology
  • Gastritis / microbiology
  • Gastritis / pathology
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / drug therapy*
  • Helicobacter Infections
  • Humans
  • Hyperplasia
  • Male
  • Middle Aged
  • Omeprazole / adverse effects
  • Omeprazole / therapeutic use*
  • Time Factors
  • Treatment Outcome


  • Anti-Ulcer Agents
  • Gastrins
  • Omeprazole