102-460: Omeprazole , sold under the brand names Prilosec and Losec , among others, is a medication used in the treatment of gastroesophageal reflux disease (GERD), peptic ulcer disease , and Zollinger–Ellison syndrome . It is also used to prevent upper gastrointestinal bleeding in people who are at high risk. Omeprazole is a proton-pump inhibitor (PPI) and its effectiveness is similar to that of other PPIs. It can be taken by mouth or by injection into
204-404: A certain probability of occurring within the limits of the estimated due date. A study of singleton live births came to the result that childbirth has a standard deviation of 14 days when gestational age is estimated by first trimester ultrasound , and 16 days when estimated directly by last menstrual period. Fertility and fecundity are the respective capacities to fertilize and establish
306-405: A clinical pregnancy and have a live birth. Infertility is an impaired ability to establish a clinical pregnancy and sterility is the permanent inability to establish a clinical pregnancy. The capacity for pregnancy depends on the reproductive system , its development and its variation , as well as on the condition of a person. Women as well as intersex and transgender people who have
408-428: A combination of an antacid and alginic acid (such as Gaviscon ) may improve symptoms by 60% (NNT=4). Metoclopramide (a prokinetic) is not recommended either alone or in combination with other treatments due to concerns around adverse effects. The benefit of the prokinetic mosapride is modest. Sucralfate has similar effectiveness to H 2 receptor blockers; however, sucralfate needs to be taken multiple times
510-511: A day, thus limiting its use. Baclofen , an agonist of the GABA B receptor, while effective, has similar issues of needing frequent dosing in addition to greater adverse effects compared to other medications. The standard surgical treatment for severe GERD is the Nissen fundoplication . In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen
612-430: A day. They should be taken one half to one hour before a meal. There is no significant difference between PPIs. When these medications are used long-term, the lowest effective dose should be taken. They may also be taken only when symptoms occur in those with frequent problems. H 2 receptor blockers lead to roughly a 40% improvement. The evidence for antacids is weaker with a benefit of about 10% ( NNT =13) while
714-509: A device called the LINX, which consists of a series of metal beads with magnetic cores that are placed surgically around the lower esophageal sphincter, for those with severe symptoms that do not respond to other treatments. Improvement of GERD symptoms is similar to those of the Nissen fundoplication, although there is no data regarding long-term effects. Compared to Nissen fundoplication procedures,
816-427: A diagnosis of poisoning in hospitalized patients. Plasma omeprazole concentrations are usually in a range of 0.2–1.2 mg/L in persons receiving the drug therapeutically by the oral route and 1–6 mg/L in people with acute overdose. Enantiomeric chromatographic methods are available to distinguish esomeprazole from racemic omeprazole. Omeprazole was first made in 1979 by Swedish AB Hässle, part of Astra AB . It
918-446: A dose-dependent effect. The inhibitory effect of omeprazole occurs within 1 hour after oral administration. The maximum effect occurs within 2 hours. The duration of inhibition is up to 72 hours. When omeprazole is stopped, baseline stomach acid secretory activity returns after 3 to 5 days. The inhibitory effect of omeprazole on acid secretion will plateau after 4 days of repeated daily dosing. The absorption of omeprazole takes place in
1020-404: A functioning female reproductive system are capable of pregnancy. In some cases, someone might be able to produce fertilizable eggs, but might not have a womb or none that can sufficiently gestate, in which case they might find surrogacy . Through an interplay of hormones that includes follicle stimulating hormone that stimulates folliculogenesis and oogenesis creates a mature egg cell ,
1122-427: A glass of water, before a meal. Additionally, most sources recommend that after taking omeprazole, at least 30 minutes should be allowed to elapse before eating (at least 60 minutes for immediate-release omeprazole plus sodium bicarbonate products, such as Zegerid). Omeprazole is completely metabolized by the cytochrome P450 system, mainly in the liver, by CYP2C19 and CYP3A4 isoenzymes . Identified metabolites are
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#17327984875221224-586: A hiatal hernia. In 1934 gastroenterologist Asher Winkelstein described reflux and attributed the symptoms to stomach acid. The most common symptoms of GERD in adults are an acidic taste in the mouth, regurgitation , and heartburn . Less common symptoms include pain with swallowing / sore throat , increased salivation (also known as water brash), nausea , chest pain , coughing , and globus sensation . The acid reflux can induce asthma attack symptoms like shortness of breath, cough, and wheezing in those with underlying asthma. GERD sometimes causes injury to
1326-413: A patented replacement drug. Many companies introduced generics as AstraZeneca's patents expired worldwide, which are available under many brand names. Omeprazole was a subject of a patent litigation in the U.S. The invention involved application of two different coatings to a drug in pill form to ensure that the omeprazole did not disintegrate before reaching its intended site of action in stomach. Although
1428-462: A positive diagnosis. Short-term treatment with proton-pump inhibitors may help predict abnormal 24-hour pH monitoring results among patients with symptoms suggestive of GERD. Endoscopy , the examination of the stomach with a fibre-optic scope, is not routinely needed if the case is typical and responds to treatment. It is recommended when people either do not respond well to treatment or have alarm symptoms, including dysphagia , anemia , blood in
1530-415: A pregnancy 12 to 15 days after fertilization. A quantitative blood test can determine approximately the date the embryo was fertilized because hCG levels double every 36 to 72 hours before 8 weeks' gestation. A single test of progesterone levels can also help determine how likely a fetus will survive in those with a threatened miscarriage (bleeding in early pregnancy), but only if the ultrasound result
1632-400: A pregnancy to a viable stage . Twins and other multiple births are counted as one pregnancy and birth. A woman who has never been pregnant is referred to as a nulligravida. A woman who is (or has been only) pregnant for the first time is referred to as a primigravida , and a woman in subsequent pregnancies as a multigravida or as multiparous. Therefore, during a second pregnancy
1734-412: A pregnancy; however, they are usually not felt until the second or third trimester. Final weight gain takes place during the third trimester; this is the most weight gain throughout the pregnancy. The woman's abdomen will transform in shape as the fetus turns in a downward position ready for birth. The woman's navel will sometimes become convex, "popping" out, due to the expanding abdomen . The uterus,
1836-478: A recurrent problem. Frequent acid reflux is due to poor closure of the lower esophageal sphincter , which is at the junction between the stomach and the esophagus. Factors that can contribute to GERD: Factors that have been linked with GERD, but not conclusively: In 1999, a review of existing studies found that, on average, 40% of GERD patients also had H. pylori infection. The eradication of H. pylori can lead to an increase in acid secretion, leading to
1938-439: A vein . It is also available in the fixed-dose combination medication omeprazole/sodium bicarbonate as Zegerid and as Konvomep. Common side effects include nausea, vomiting, headaches, abdominal pain, and increased intestinal gas . Serious side effects may include Clostridioides difficile colitis , an increased risk of pneumonia , an increased risk of bone fractures , and the potential of masking stomach cancer . Whether it
2040-460: A woman undergoes many normal physiological changes, including behavioral , cardiovascular , hematologic , metabolic , renal , and respiratory changes. Increases in blood sugar , breathing , and cardiac output are all required. Levels of progesterone and estrogens rise continually throughout pregnancy, suppressing the hypothalamic axis and therefore the menstrual cycle . A full-term pregnancy at an early age (less than 25 years) reduces
2142-913: A woman would be described as gravida 2, para 1 and upon live delivery as gravida 2, para 2. In-progress pregnancies, abortions , miscarriages and/or stillbirths account for parity values being less than the gravida number. Women who have never carried a pregnancy more than 20 weeks are referred to as nulliparous . A pregnancy is considered term at 37 weeks of gestation. It is preterm if less than 37 weeks and postterm at or beyond 42 weeks of gestation. American College of Obstetricians and Gynecologists have recommended further division with early term 37 weeks up to 39 weeks, full term 39 weeks up to 41 weeks, and late term 41 weeks up to 42 weeks. The terms preterm and postterm have largely replaced earlier terms of premature and postmature . Preterm and postterm are defined above, whereas premature and postmature have historical meaning and relate more to
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#17327984875222244-531: Is ranitidine and PPIs. Babies may see relief with smaller, more frequent feedings, more frequent burping during feedings, holding the baby in an upright position 30 minutes after feeding, keeping the baby's head elevated while laying on the back, removing milk and soy from the mother's diet or feeding the baby milk protein-free formula. They may also be treated with medicines such as ranitidine or proton pump inhibitors. Proton pump inhibitors, however, have not been found to be effective in this population and there
2346-516: Is vagotomy ("highly selective vagotomy"), the surgical removal of vagus nerve branches that innervate the stomach lining. This treatment has been largely replaced by medication. Vagotomy by itself tended to worsen contraction of the pyloric sphincter of the stomach, and delayed stomach emptying. Historically, vagotomy was combined with pyloroplasty or gastroenterostomy to counter this problem. A number of endoscopic devices have been tested to treat chronic heartburn. Pregnancy Pregnancy
2448-478: Is a eutomer , purely the ( S )-enantiomer, rather than a racemate like omeprazole. Omeprazole undergoes a chiral shift in vivo which converts the inactive ( R )-enantiomer to the active ( S )-enantiomer, doubling the concentration of the active form. This chiral shift is accomplished by the CYP2C19 isozyme of cytochrome P450 , which is not found equally in all human populations. Those who do not metabolize
2550-404: Is a chronic upper gastrointestinal disease in which stomach content persistently and regularly flows up into the esophagus , resulting in symptoms and/or complications. Symptoms include dental corrosion, dysphagia , heartburn , odynophagia , regurgitation , non-cardiac chest pain, extraesophageal symptoms such as chronic cough , hoarseness , reflux-induced laryngitis , or asthma . In
2652-420: Is a common response to GERD symptoms and many people get more of this kind of treatment than their case merits. The overuse of acid suppression is a problem because of the side effects and costs. Proton-pump inhibitors (PPIs), such as omeprazole , are the most effective, followed by H 2 receptor blockers, such as ranitidine . If a once-daily PPI is only partially effective they may be used twice
2754-413: Is a lack of evidence for safety. The role of an occupational therapist with an infant with GERD includes positioning during and after feeding. One technique used is called the log-roll technique, which is practiced when changing an infant's clothing or diapers. Placing an infant on their back while having their legs lifted is not recommended since it causes the acid to flow back up the esophagus. Instead,
2856-580: Is a standard way of calculating the due date for a pregnancy when assuming a gestational age of 280 days at childbirth. The rule estimates the expected date of delivery (EDD) by adding a year, subtracting three months, and adding seven days to the origin of gestational age. Alternatively there are mobile apps , which essentially always give consistent estimations compared to each other and correct for leap year , while pregnancy wheels made of paper can differ from each other by 7 days and generally do not correct for leap year. Furthermore, actual childbirth has only
2958-623: Is also a competitive inhibitor of p-glycoprotein , as are other PPIs. Drugs that depend on an acidic stomach environment (such as ketoconazole or atazanavir ) may be poorly absorbed, whereas acid-labile antibiotics (such as erythromycin which is a very strong CYP3A4 inhibitor) may be absorbed to a greater extent than normal due to the more alkaline environment of the stomach. St. John's wort ( Hypericum perforatum ) and Ginkgo biloba significantly reduce plasma concentrations of omeprazole through induction of CYP3A4 and CYP2C19. Proton-pump inhibitors like omeprazole have been found to increase
3060-860: Is also available without a prescription in the United States. Omeprazole can be used in the treatment of gastroesophageal reflux disease (GERD), peptic ulcers , erosive esophagitis , Zollinger–Ellison syndrome , and eosinophilic esophagitis . Peptic ulcers may be treated with omeprazole. Infection with Helicobacter pylori can be treated by taking omeprazole, amoxicillin , and clarithromycin together for 7–14 days. Amoxicillin may be replaced with metronidazole in patients who are allergic to penicillin. Adverse effects occurring in at least 1% of people include: Other concerns related to adverse effects are: Concern has been expressed regarding vitamin B 12 and iron malabsorption , but effects seem to be insignificant, especially when supplement therapy
3162-474: Is at its highest. Around the middle of the second trimester, movement of the fetus may be felt. At 28 weeks, more than 90% of babies can survive outside of the uterus if provided with high-quality medical care , though babies born at this time will likely experience serious health complications such as heart and respiratory problems and long-term intellectual and developmental disabilities. Prenatal care improves pregnancy outcomes. Nutrition during pregnancy
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3264-403: Is called "full term". Whenever possible, waiting for labor to begin on its own in this time period is best for the health of the mother and baby. The decision to perform an induction must be made after weighing the risks and benefits, but is safer after 39 weeks. Events after 42 weeks are considered postterm . When a pregnancy exceeds 42 weeks, the risk of complications for both the woman and
3366-406: Is divided into three trimesters of approximately three months each. The first trimester includes conception, which is when the sperm fertilizes the egg. The fertilized egg then travels down the fallopian tube and attaches to the inside of the uterus , where it begins to form the embryo and placenta . During the first trimester, the possibility of miscarriage (natural death of embryo or fetus)
3468-496: Is due to decreased stomach acid production. The safety of using omeprazole has not been established in pregnant or breastfeeding women. Epidemiological data do not show an increased risk of major birth defects after maternal use of omeprazole during pregnancy . Important drug interactions are rare. However, the most significant major drug interaction concern is the decreased activation of clopidogrel when taken together with omeprazole. Although still controversial, this may increase
3570-406: Is due to poor closure of the lower esophageal sphincter , which is at the junction between the stomach and the esophagus. Diagnosis among those who do not improve with simpler measures may involve gastroscopy , upper GI series , esophageal pH monitoring , or esophageal manometry . Treatment options include lifestyle changes, medications, and sometimes surgery for those who do not improve with
3672-401: Is important to ensure healthy growth of the fetus. Prenatal care may also include avoiding recreational drugs (including tobacco and alcohol ), taking regular exercise, having blood tests , and regular physical examinations . Complications of pregnancy may include disorders of high blood pressure , gestational diabetes , iron-deficiency anemia , and severe nausea and vomiting . In
3774-438: Is known as a blastocyst . The blastocyst arrives at the uterus and attaches to the uterine wall, a process known as implantation . The development of the mass of cells that will become the infant is called embryogenesis during the first approximately ten weeks of gestation. During this time, cells begin to differentiate into the various body systems. The basic outlines of the organ, body, and nervous systems are established. By
3876-452: Is more effective than partial anterior fundoplication surgery, and partial fundoplication has better outcomes than total fundoplication. Esophagogastric dissociation is an alternative procedure that is sometimes used to treat neurologically impaired children with GERD. Preliminary studies have shown it may have a lower failure rate and a lower incidence of recurrent reflux. In 2012 the U.S. Food and Drug Administration (FDA) approved
3978-472: Is not needed in those in whom Barrett's esophagus is seen. Investigation for H. pylori is not usually needed. The current gold standard for diagnosis of GERD is esophageal pH monitoring. It is the most objective test to diagnose the reflux disease and allows monitoring GERD patients in their response to medical or surgical treatment. One practice for diagnosis of GERD is a short-term treatment with proton-pump inhibitors, with improvement in symptoms suggesting
4080-466: Is not recommended unless required for other medical reasons. Associated terms for pregnancy are gravid and parous . Gravidus and gravid come from the Latin word meaning "heavy" and a pregnant female is sometimes referred to as a gravida . Gravidity refers to the number of times that a female has been pregnant. Similarly, the term parity is used for the number of times that a female carries
4182-494: Is often safer and less expensive than taking prescription drugs. Some guidelines recommend trying to treat symptoms with an H 2 antagonist before using a proton-pump inhibitor because of cost and safety concerns. Medical nutrition therapy plays an essential role in managing the symptoms of the disease by preventing reflux, preventing pain and irritation, and decreasing gastric secretions. Some foods such as chocolate, mint, high-fat food, and alcohol have been shown to relax
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4284-410: Is primitive neural activity rather than the beginning of conscious brain activity. Synapses do not begin to form until week 17. Neural connections between the sensory cortex and thalamus develop as early as 24 weeks' gestational age, but the first evidence of their function does not occur until around 30 weeks, when minimal consciousness , dreaming , and the ability to feel pain emerges. Although
4386-500: Is provided. Since their introduction, proton-pump inhibitors (PPIs, especially omeprazole) have also been associated with several cases of acute interstitial nephritis , an inflammation of the kidneys that often occurs as an adverse drug reaction. Long-term use of PPIs is strongly associated with the development of benign polyps from fundic glands (which is distinct from fundic gland polyposis ); these polyps do not cause cancer and resolve when PPIs are discontinued. No association
4488-494: Is safe for use in pregnancy is unclear. It works by blocking the release of stomach acid . Omeprazole was patented in 1978 and approved for medical use in 1988. It is on the World Health Organization's List of Essential Medicines . It is available as a generic medication . In 2022, it was the ninth most commonly prescribed medication in the United States, with more than 52 million prescriptions. It
4590-663: Is seen between PPI use and cancer, but use of PPIs may mask gastric cancers or other serious gastric problems and physicians should be aware of this effect. There is a possible association between long term use and dementia which requires further study to confirm. A review article in U.S. Pharmacist in 2013 states that long-term use of PPIs is associated with decreased calcium absorption (causing increased risk of osteoporosis and fractures ), decreased magnesium absorption (causing electrolyte disturbances ), and increased risk of certain infections such as C. difficile and community-acquired pneumonia . They hypothesize that this
4692-465: Is sometimes called silent reflux . Differential diagnosis of GERD can also include dyspepsia, peptic ulcer disease, esophageal and gastric cancer, and food allergies. The treatments for GERD may include food choices, lifestyle changes, medications, and possibly surgery. Initial treatment is frequently with a proton-pump inhibitor such as omeprazole . In some cases, a person with GERD symptoms can manage them by taking over-the-counter drugs . This
4794-454: Is sometimes used as the initiation of pregnancy, with the derived age being termed fertilization age . Fertilization usually occurs about two weeks before the next expected menstrual period. A third point in time is also considered by some people to be the true beginning of a pregnancy: This is time of implantation, when the future fetus attaches to the lining of the uterus. This is about a week to ten days after fertilization. The sperm and
4896-461: Is the connecting cord from the embryo or fetus to the placenta. After about ten weeks of gestational age—which is the same as eight weeks after conception—the embryo becomes known as a fetus . At the beginning of the fetal stage, the risk of miscarriage decreases sharply. At this stage, a fetus is about 30 mm (1.2 inches) in length, the heartbeat is seen via ultrasound, and the fetus makes involuntary motions. During continued fetal development,
4998-469: Is the time during which one or more offspring develops ( gestates ) inside a woman 's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins . Pregnancy usually occurs by sexual intercourse , but can also occur through assisted reproductive technology procedures. A pregnancy may end in a live birth , a miscarriage , an induced abortion , or a stillbirth . Childbirth typically occurs around 40 weeks from
5100-634: Is unavoidable. However, spontaneous birth after 37 weeks is considered term and is not associated with the same risks of a preterm birth. Planned birth before 39 weeks by caesarean section or labor induction , although "at term", results in an increased risk of complications. This is from factors including underdeveloped lungs of newborns , infection due to underdeveloped immune system, feeding problems due to underdeveloped brain, and jaundice from underdeveloped liver. Babies born between 39 and 41 weeks' gestation have better outcomes than babies born either before or after this range. This special time period
5202-438: Is uncertain, but is estimated at 20% of cases. Due to the risk of chronic heartburn progressing to Barrett's, EGD every five years is recommended for people with chronic heartburn, or who take drugs for chronic GERD. A small amount of acid reflux is typical even in healthy people (as with infrequent and minor heartburn ), but gastroesophageal reflux becomes gastroesophageal reflux disease when signs and symptoms develop into
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#17327984875225304-416: Is widely experienced as painful, some women do report painless labors, while others find that concentrating on the birth helps to quicken labor and lessen the sensations. Most births are successful vaginal births, but sometimes complications arise and a woman may undergo a cesarean section . During the time immediately after birth, both the mother and the baby are hormonally cued to bond, the mother through
5406-549: The Western world , between 10 and 20% of the population is affected by GERD. It is highly prevalent in North America with 18% to 28% of the population suffering from the condition. Occasional gastroesophageal reflux without troublesome symptoms or complications is even more common. The classic symptoms of GERD were first described in 1925, when Friedenwald and Feldman commented on heartburn and its possible relationship to
5508-523: The fertilization age , which is the age of the embryo since conception. The American Congress of Obstetricians and Gynecologists recommends the following methods to calculate gestational age: Pregnancy is divided into three trimesters, each lasting for approximately three months. The exact length of each trimester can vary between sources. Due date estimation basically follows two steps: The American College of Obstetricians and Gynecologists divides full term into three divisions: Naegele's rule
5610-424: The sulfone , the sulfide , and hydroxy-omeprazole, which exert no significant effect on acid secretion. About 77% of an orally given dose is excreted as metabolites in the urine, and the remainder is found in the feces, primarily originating from bile secretion. Omeprazole has a half life of 0.5 to 1 hour. Omeprazole contains a tricoordinated sulfinyl sulfur in a pyramidal structure and therefore can exist as either
5712-515: The ( S )- or ( R )- enantiomers . Omeprazole is a racemate , an equal mixture of the two. In the acidic conditions of the canaliculi of parietal cells , both enantiomers are converted to achiral products ( sulfenic acid and sulfenamide configurations) which react with a cysteine group in H/K ATPase , thereby inhibiting the ability of the parietal cells to produce gastric acid . AstraZeneca also developed esomeprazole (Nexium) which
5814-462: The CYP3A4 and CYP2D6 pathways, and inhibition of these enzymes results in a higher area under the curve (i.e., the total effect over time of a given dose). Other examples of drugs dependent on CYP3A4 for their metabolism are escitalopram , warfarin , oxycodone , tramadol , and oxymorphone . The concentrations of these drugs may increase if they are used concomitantly with omeprazole. Omeprazole
5916-483: The H/K-ATPase system found at the secretory surface of gastric parietal cells . Because this enzyme system is regarded as the acid (proton, or H) pump within the gastric mucosa , omeprazole inhibits the final step of acid production. Omeprazole also inhibits both basal and stimulated acid secretion irrespective of the stimulus as it blocks the last step in acid secretion. The drug binds non-competitively so it has
6018-569: The Johnson-DeMeester's scoring system: 0 – None 1 – Minimal – occasional episodes 2 – Moderate – medical therapy visits 3 – Severe – interference with daily activities Other causes of chest pain such as heart disease should be ruled out before making the diagnosis. Another kind of acid reflux, which causes respiratory and laryngeal signs and symptoms, is called laryngopharyngeal reflux (LPR) or extraesophageal reflux disease (EERD). Unlike GERD, LPR rarely produces heartburn, and
6120-440: The United States, 60% of the women used birth control to some extent during the month pregnancy began. The usual signs and symptoms of pregnancy do not significantly interfere with activities of daily living or pose a health-threat to the mother or baby. However, pregnancy complications can cause other more severe symptoms, such as those associated with anemia . Common signs and symptoms of pregnancy include: (from
6222-479: The absence of perikymata , together with intact enamel along the gum margin. It will be evident in people with restorations as tooth structure typically dissolves much faster than the restorative material, causing it to seem as if it "stands above" the surrounding tooth structure. GERD may lead to Barrett's esophagus , a type of intestinal metaplasia , which is in turn a precursor condition for esophageal cancer . The risk of progression from Barrett's to dysplasia
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#17327984875226324-543: The bottle or breast only to cry for it again, failure to gain adequate weight, bad breath, and burping are also common. Children may have one symptom or many; no single symptom is universal in all children with GERD. Of the estimated 4 million babies born in the US each year, up to 35% of them may have difficulties with reflux in the first few months of their lives, known as 'spitting up'. About 90% of infants will outgrow their reflux by their first birthday. Acid reflux into
6426-422: The diagnosis requires both symptoms or complications and reflux of stomach content. Other investigations may include esophagogastroduodenoscopy (EGD). Barium swallow X-rays should not be used for diagnosis. Esophageal manometry is not recommended for use in the diagnosis, being recommended only prior to surgery. Ambulatory esophageal pH monitoring may be useful in those who do not improve after PPIs and
6528-552: The drug effectively are called "poor metabolizers". The proportion of the poor metabolizer phenotype varies widely between populations, from 2.0 to 2.5% in African Americans and white Americans to >20% in Asians. Several pharmacogenomics studies have suggested that PPI treatment should be tailored according to CYP2C19 metabolism status. Omeprazole may be quantified in plasma or serum to monitor therapy or to confirm
6630-426: The early body systems, and structures that were established in the embryonic stage continue to develop. Sex organs begin to appear during the third month of gestation. The fetus continues to grow in both weight and length, although the majority of the physical growth occurs in the last weeks of pregnancy. Electrical brain activity is first detected at the end of week 5 of gestation, but as in brain-dead patients, it
6732-407: The egg cell, which has been released from one of the female's two ovaries , unite in one of the two fallopian tubes . The fertilized egg, known as a zygote , then moves toward the uterus, a journey that can take up to a week to complete. Cell division begins approximately 24 to 36 hours after the female and male cells unite. Cell division continues at a rapid rate and the cells then develop into what
6834-434: The end of the embryonic stage, the beginnings of features such as fingers, eyes, mouth, and ears become visible. Also during this time, there is development of structures important to the support of the embryo, including the placenta and umbilical cord . The placenta connects the developing embryo to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. The umbilical cord
6936-450: The enlarged uterus may impede blood flow by compressing the vena cava when lying flat, a condition that can be relieved by lying on the left side. Childbirth, referred to as labor and delivery in the medical field, is the process whereby an infant is born. A woman is considered to be in labor when she begins experiencing regular uterine contractions, accompanied by changes of her cervix—primarily effacement and dilation. While childbirth
7038-582: The esophagus. These injuries may include one or more of the following: GERD sometimes causes injury of the larynx (LPR). Other complications can include aspiration pneumonia . GERD may be difficult to detect in infants and children since they cannot describe what they are feeling and indicators must be observed. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting , effortless spitting up, coughing , and other respiratory problems, such as wheezing. Inconsolable crying, refusing food, crying for food and then pulling off
7140-645: The female gamete . Fertilization is the event where the egg cell fuses with the male gamete, spermatozoon . After the point of fertilization, the fused product of the female and male gamete is referred to as a zygote or fertilized egg. The fusion of female and male gametes usually occurs following the act of sexual intercourse . Pregnancy rates for sexual intercourse are highest during the menstrual cycle time from some 5 days before until 1 to 2 days after ovulation. Fertilization can also occur by assisted reproductive technology such as artificial insemination and in vitro fertilisation . Fertilization (conception)
7242-470: The fetus begins to move during the first trimester, it is not until the second trimester that movement, known as quickening , can be felt. This typically happens in the fourth month, more specifically in the 20th to 21st week, or by the 19th week if the woman has been pregnant before. It is common for some women not to feel the fetus move until much later. During the second trimester, when the body size changes, maternity clothes may be worn. During pregnancy,
7344-549: The fetus increases significantly. Therefore, in an otherwise uncomplicated pregnancy, obstetricians usually prefer to induce labor at some stage between 41 and 42 weeks. The postpartum period also referred to as the puerperium , is the postnatal period that begins immediately after delivery and extends for about six weeks. During this period, the mother's body begins the return to pre-pregnancy conditions that includes changes in hormone levels and uterus size. The beginning of pregnancy may be detected either based on symptoms by
7446-478: The first seven weeks following implantation (i.e. ten weeks' gestational age), after which the term fetus is used until birth. Signs and symptoms of early pregnancy may include missed periods , tender breasts, morning sickness (nausea and vomiting), hunger, implantation bleeding , and frequent urination. Pregnancy may be confirmed with a pregnancy test . Methods of birth control —or, more accurately, contraception —are used to avoid pregnancy. Pregnancy
7548-566: The first trimester, minute ventilation increases by 40 percent. The womb will grow to the size of a lemon by eight weeks. Many symptoms and discomforts of pregnancy , such as nausea and tender breasts , appear in the first trimester. During the second trimester, most women feel more energized and put on weight as the symptoms of morning sickness subside. They begin to feel regular fetal movements , which can become strong and even disruptive. Braxton Hicks contractions are sporadic uterine contractions that may start around six weeks into
7650-435: The first two measures. Lifestyle changes include not lying down for three hours after eating, lying down on the left side, raising the pillow or bedhead height, losing weight, and stopping smoking. Foods that may precipitate GERD symptoms include coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods. Medications include antacids , H 2 receptor blockers , proton pump inhibitors , and prokinetics . In
7752-496: The ideal childbirth, labor begins on its own "at term". Babies born before 37 weeks are " preterm " and at higher risk of health problems such as cerebral palsy . Babies born between weeks 37 and 39 are considered "early term" while those born between weeks 39 and 41 are considered "full term". Babies born between weeks 41 and 42 weeks are considered "late-term" while after 42 weeks they are considered " post-term ". Delivery before 39 weeks by labor induction or caesarean section
7854-792: The infant's size and state of development rather than to the stage of pregnancy. About 213 million pregnancies occurred in 2012, of which, 190 million (89%) were in the developing world and 23 million (11%) were in the developed world. The number of pregnancies in women aged between 15 and 44 is 133 per 1,000 women. About 10% to 15% of recognized pregnancies end in miscarriage . In 2016, complications of pregnancy resulted in 230,600 maternal deaths , down from 377,000 deaths in 1990. Common causes include bleeding , infections , hypertensive diseases of pregnancy , obstructed labor , miscarriage, abortion, or ectopic pregnancy . Globally, 44% of pregnancies are unplanned . Over half (56%) of unplanned pregnancies are aborted. Among unintended pregnancies in
7956-429: The long term, and when not treated, complications such as esophagitis , esophageal stricture , and Barrett's esophagus may arise. Risk factors include obesity , pregnancy , smoking , hiatal hernia , and taking certain medications. Medications that may cause or worsen the disease include benzodiazepines , calcium channel blockers , tricyclic antidepressants , NSAIDs , and certain asthma medicines. Acid reflux
8058-971: The lower esophageal sphincter, increasing the risk of reflux. Weight loss is recommended for the overweight or obese, as well as avoidance of bedtime snacks or lying down immediately after meals (meals should occur at least 2–3 hours before bedtime), elevation of the head of the bed on 6-inch blocks, avoidance of smoking, and avoidance of tight clothing that increases pressure in the stomach. It may be beneficial to avoid spices, citrus juices, tomatoes and soft drinks , and to consume small frequent meals and drink liquids between meals. Some evidence suggests that reduced sugar intake and increased fiber intake can help. Although moderate exercise may improve symptoms in people with GERD, vigorous exercise may worsen them. Breathing exercises may relieve GERD symptoms. The primary medications used for GERD are proton-pump inhibitors, H 2 receptor blockers and antacids with or without alginic acid . The use of acid suppression therapy
8160-470: The mother during their first two hours after birth, the period that they tend to be more alert than in the following hours of early life. In the ideal childbirth , labor begins on its own when a woman is "at term". Events before completion of 37 weeks are considered preterm. Preterm birth is associated with a range of complications and should be avoided if possible. Sometimes if a woman's water breaks or she has contractions before 39 weeks, birth
8262-428: The mouth can cause breakdown of the enamel, especially on the inside surface of the teeth. A dry mouth, acid or burning sensation in the mouth, bad breath and redness of the palate may occur. Less common symptoms of GERD include difficulty in swallowing, water brash, chronic cough, hoarse voice, nausea and vomiting. Signs of enamel erosion are the appearance of a smooth, silky-glazed, sometimes dull, enamel surface with
8364-441: The muscular organ that holds the developing fetus, can expand up to 20 times its normal size during pregnancy. Head engagement , also called "lightening" or "dropping", occurs as the fetal head descends into a cephalic presentation . While it relieves pressure on the upper abdomen and gives a renewed ease in breathing, it also severely reduces bladder capacity, resulting in a need to void more frequently , and increases pressure on
8466-469: The occupational therapist would suggest rolling the child on the side, keeping the shoulders and hips aligned to avoid acid rising up the baby's esophagus. Another technique used is feeding the baby on their side with an upright position instead of lying flat on their back. The final positioning technique used for infants is to keep them on their stomach or upright for 20 minutes after feeding. In Western populations, GERD affects approximately 10% to 20% of
8568-449: The patient and damage to the device. Some patients who are at an increased surgical risk or do not tolerate PPIs may qualify for a more recently developed incisionless procedure known as a TIF transoral incisionless fundoplication . Benefits of this procedure may last for up to six years. GERD is a common condition that develops during pregnancy, but usually resolves after delivery. The severity of symptoms tend to increase throughout
8670-416: The pelvic floor and the rectum. It is not possible to predict when lightening will occur. In a first pregnancy it may happen a few weeks before the due date, though it may happen later or even not until labor begins, as is typical with subsequent pregnancies. It is during the third trimester that maternal activity and sleep positions may affect fetal development due to restricted blood flow . For instance,
8772-684: The physical changes. This condition is known as a false pregnancy . Most pregnant women experience a number of symptoms, which can signify pregnancy. A number of early medical signs are associated with pregnancy. These signs include: Pregnancy detection can be accomplished using one or more various pregnancy tests , which detect hormones generated by the newly formed placenta , serving as biomarkers of pregnancy. Blood and urine tests can detect pregnancy by 11 and 14 days, respectively, after fertilization. Blood pregnancy tests are more sensitive than urine tests (giving fewer false negatives). Home pregnancy tests are urine tests, and normally detect
8874-411: The plasma concentrations of methotrexate . Omeprazole irreversibly blocks the enzyme system on parietal cells that is needed for the secretion of gastric acid. It is a specific H/KATPase inhibitor. This is the enzyme needed for the final step in the secretion of gastric acid. Omeprazole is a selective and irreversible proton pump inhibitor. It suppresses stomach acid secretion by specific inhibition of
8976-435: The population and 0.4% newly develop the condition. For instance, an estimated 3.4 million to 6.8 million Canadians have GERD. The prevalence rate of GERD in developed nations is also tightly linked with age, with adults aged 60 to 70 being the most commonly affected. In the United States 20% of people have symptoms in a given week and 7% every day. No data supports sex predominance with regard to GERD. An obsolete treatment
9078-693: The pregnancy. In pregnancy, dietary modifications and lifestyle changes may be attempted, but often have little effect. Some lifestyle changes that can be implemented are elevating the head of the bed, eating small portions of food at regularly scheduled intervals, reduce fluid intake with a meal, avoid eating three hours before bedtime, and refrain from lying down after eating. Calcium-based antacids are recommended if these changes are not effective; aluminum- and magnesium hydroxide-based antacids are also safe. Antacids that contain sodium bicarbonate or magnesium trisilicate should be avoided in pregnancy. Sucralfate has been studied in pregnancy and proven to be safe as
9180-529: The procedure has shown a reduction in complications such as gas bloat syndrome that commonly occur. Adverse responses include difficulty swallowing, chest pain, vomiting, and nausea. Contraindications that would advise against use of the device are patients who are or may be allergic to titanium , stainless steel , nickel , or ferrous iron materials. A warning advises that the device should not be used by patients who could be exposed to, or undergo, magnetic resonance imaging (MRI) because of serious injury to
9282-433: The question of whether H. pylori -infected GERD patients are any different from non-infected GERD patients. A double-blind study, reported in 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity. The diagnosis of GERD is usually made when typical symptoms are present. Reflux can be present in people without symptoms and
9384-487: The release of oxytocin , a hormone also released during breastfeeding . Studies show that skin-to-skin contact between a mother and her newborn immediately after birth is beneficial for both the mother and baby. A review done by the World Health Organization found that skin-to-skin contact between mothers and babies after birth reduces crying, improves mother–infant interaction, and helps mothers to breastfeed successfully. They recommend that neonates be allowed to bond with
9486-451: The risk of breast , ovarian , and endometrial cancer , and the risk declines further with each additional full-term pregnancy. The fetus is genetically different from its mother and can therefore be viewed as an unusually successful allograft . The main reason for this success is increased immune tolerance during pregnancy, which prevents the mother's body from mounting an immune system response against certain triggers. During
9588-448: The risk of stroke or heart attack in people taking clopidogrel to prevent these events. This interaction is possible because omeprazole is an inhibitor of the enzymes CYP2C19 and CYP3A4 . Clopidogrel is an inactive prodrug that partially depends on CYP2C19 for conversion to its active form. Inhibition of CYP2C19 may block the activation of clopidogrel, which could reduce its effects. Almost all benzodiazepines are metabolised by
9690-465: The small intestine and is usually completed within 3 to 6 hours. The systemic bioavailability of omeprazole after repeated doses is about 60%. Omeprazole has a volume of distribution of 0.4 L/kg. It has high plasma protein binding of 95%. Omeprazole, as well as other PPIs, are only effective on active H/K-ATPase pumps. These pumps are stimulated in the presence of food to aid in digestion. For this reason, patients should be advised to take omeprazole with
9792-516: The solution by means of two coating was obvious, the patent was found valid, because the source of the problem was non-obvious and was discovered by the patentee. In September 2023, AstraZeneca announced it would pay $ 425 million to settle product liability litigations against Prilosec in the United States. Brand names include Losec, Prilosec, Zegerid, Miracid, and Omez. Gastroesophageal reflux disease Gastroesophageal reflux disease ( GERD ) or gastro-oesophageal reflux disease ( GORD )
9894-419: The sphincter and prevent acid reflux and to repair a hiatal hernia. It is recommended only for those who do not improve with PPIs. Quality of life is improved in the short term compared to medical therapy, but there is uncertainty in the benefits of surgery versus long-term medical management with proton pump inhibitors. When comparing different fundoplication techniques, partial posterior fundoplication surgery
9996-402: The start of the last menstrual period (LMP), a span known as the gestational age . This is just over nine months. Counting by fertilization age , the length is about 38 weeks. Pregnancy is "the presence of an implanted human embryo or fetus in the uterus"; implantation occurs on average 8–9 days after fertilization. An embryo is the term for the developing offspring during
10098-491: The start of the last menstrual period ) The chronology of pregnancy is, unless otherwise specified, generally given as gestational age , where the starting point is the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. This model means that the woman is counted as being "pregnant" two weeks before conception and three weeks before implantation . Sometimes, timing may also use
10200-435: The stool (detected chemically), wheezing , weight loss, or voice changes. Some physicians advocate either once-in-a-lifetime or 5- to 10-yearly endoscopy for people with longstanding GERD, to evaluate the possible presence of dysplasia or Barrett's esophagus. Biopsies performed during gastroscopy may show: Reflux changes that are not erosive in nature lead to "nonerosive reflux disease". Severity may be documented with
10302-447: The woman herself, or by using pregnancy tests . However, an important condition with serious health implications that is quite common is the denial of pregnancy by the pregnant woman. About 1 in 475 denials will last until around the 20th week of pregnancy. The proportion of cases of denial, persisting until delivery is about 1 in 2500. Conversely, some non-pregnant women have a very strong belief that they are pregnant along with some of
10404-707: Was the first of the proton pump inhibitors (PPI). Astra AB , now AstraZeneca, launched it as an ulcer medicine under the name Losec in Sweden. It was first sold in the United States in 1989 under the brand name Losec. In 1990, at the request of the U.S. Food and Drug Administration , the brand name Losec was changed to Prilosec to avoid confusion with the diuretic Lasix ( furosemide ). The new name led to confusion between omeprazole (Prilosec) and fluoxetine (Prozac), an antidepressant . When Prilosec's U.S. patent expired in April 2001, AstraZeneca introduced esomeprazole (Nexium) as
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