{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:54:45Z","timestamp":1792173285562,"version":"4.4.0"},"reference-count":33,"publisher":"American Veterinary Medical Association (AVMA)","issue":"11","license":[{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["javma"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate associations between cumulative oral omeprazole administration and the occurrence of exercise-induced pulmonary hemorrhage (EIPH), epistaxis, atrial fibrillation, and fracture in Thoroughbred racehorses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study of 2,924 Thoroughbred racehorses in training in Hong Kong during the 2012\u20132013 and 2022\u20132023 racing seasons was performed with veterinary, training, and racing records. Time-to-event analyses were performed with Cox proportional hazards models, with cumulative omeprazole dose fitted as a time-varying covariate and adjustment for trainer, recent training intensity, racing year, and age at first trackwork.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cumulative omeprazole administration during the preceding 30 days was associated with an increased hazard of EIPH detection (hazard ratio, 1.08 for each 10-g increase; 95% CI, 1.01 to 1.15). A similar direction of association was observed for epistaxis (hazard ratio, 1.20; 95% CI, 0.99 to 1.45). Effect estimates were close to null for associations between cumulative omeprazole administration and fracture (hazard ratio, 1.02 for each 10-g increase over 60 days; 95% CI, 0.89 to 1.17) or atrial fibrillation (hazard ratio, 1.02 for each 10-g increase over 30 days; 95% CI, 0.86 to 1.20).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Recent cumulative omeprazole administration was not associated with fracture or atrial fibrillation in this population of Thoroughbred racehorses. However, recent omeprazole administration was associated with an increased hazard of EIPH detection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>These findings supported careful consideration of the indication and duration of omeprazole administration in racehorses, particularly when administered prophylactically.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2460\/javma.26.04.0319","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T13:31:58Z","timestamp":1784122318000},"page":"1466-1473","source":"Crossref","is-referenced-by-count":0,"title":["Cumulative omeprazole administration is associated with increased hazard of exercise-induced pulmonary hemorrhage detection in Thoroughbred racehorses"],"prefix":"10.2460","volume":"264","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4034-5794","authenticated-orcid":true,"given":"Olivia J.","family":"Jones","sequence":"first","affiliation":[{"name":"School of Veterinary Science, University of Queensland, Gatton, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J.","family":"Ahern","sequence":"additional","affiliation":[{"name":"School of Veterinary Science, University of Queensland, Gatton, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian D.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Veterinary Clinical Sciences, Hong Kong Jockey Club, Sha Tin, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8926-5942","authenticated-orcid":true,"given":"John M.","family":"Morton","sequence":"additional","affiliation":[{"name":"Jemora Pty Ltd, East Geelong, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie L.","family":"Robotham","sequence":"additional","affiliation":[{"name":"Department of Veterinary Clinical Sciences, Hong Kong Jockey Club, Sha Tin, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica C.","family":"Wise","sequence":"additional","affiliation":[{"name":"School of Veterinary Science, University of Queensland, Gatton, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1272","reference":[{"issue":"4","key":"ref1","series-title":"Therap Adv Gastroenterol","first-page":"219","article-title":"Overutilization of proton-pump inhibitors: what the clinician needs to know","volume":"5","author":"Heidelbaugh JJ","year":"2012","unstructured":"Heidelbaugh JJ, Kim AH, Chang R, Walker PC. Overutilization of proton-pump inhibitors: what the clinician needs to know. Therap Adv Gastroenterol. 2012;5(4):219-232. doi:10.1177\/1756283X12437358"},{"issue":"10","key":"ref2","series-title":"Equine Vet Educ","first-page":"556","article-title":"A free ride: is long-term omeprazole therapy safe and effective?","volume":"33","author":"Sykes BW","year":"2021","unstructured":"Sykes BW. A free ride: is long-term omeprazole therapy safe and effective? Equine Vet Educ. 2021;33(10):556-560. doi:10.1111\/eve.13458"},{"issue":"3","key":"ref3","series-title":"World J Gastrointest Pharmacol Ther","first-page":"17","article-title":"Proton pump inhibitor-associated pneumonia: not a breath of fresh air after all?","volume":"2","author":"Fohl AL","year":"2011","unstructured":"Fohl AL, Regal RE. Proton pump inhibitor-associated pneumonia: not a breath of fresh air after all? World J Gastrointest Pharmacol Ther. 2011;2(3):17-26. doi:10.4292\/wjgpt.v2.i3.17"},{"issue":"6","key":"ref4","series-title":"PLoS One","first-page":"e0124653","article-title":"Proton pump inhibitor usage and the risk of myocardial infarction in the general population","volume":"10","author":"Shah NH","year":"2015","unstructured":"Shah NH, LePendu P, Bauer-Mehren A,  Proton pump inhibitor usage and the risk of myocardial infarction in the general population. PLoS One. 2015;10(6):e0124653. doi:10.1371\/journal.pone.0124653"},{"key":"ref5","series-title":"Front Cardiovasc Med","first-page":"767987","article-title":"Updated insights on cardiac and vascular risks of proton pump inhibitors: a real-world pharmacovigilance study","volume":"9","author":"Zhai Y","year":"2022","unstructured":"Zhai Y, Ye X, Hu F,  Updated insights on cardiac and vascular risks of proton pump inhibitors: a real-world pharmacovigilance study. Front Cardiovasc Med. 2022;9:767987. doi:10.3389\/fcvm.2022.767987"},{"issue":"5","key":"ref6","series-title":"Expert Rev Cardiovasc Ther","first-page":"345","article-title":"Proton pump inhibitor-induced hypomagnesemia complicated with serious cardiac arrhythmias","volume":"17","author":"Chrysant SG","year":"2019","unstructured":"Chrysant SG. Proton pump inhibitor-induced hypomagnesemia complicated with serious cardiac arrhythmias. Expert Rev Cardiovasc Ther. 2019;17(5):345-351. doi:10.1080\/14779072.2019.1615446"},{"issue":"7","key":"ref7","series-title":"Am J Med","first-page":"778","article-title":"Effects of proton pump inhibitors on calcium carbonate absorption in women: a randomized crossover trial","volume":"118","author":"O\u2019Connell MB","year":"2005","unstructured":"O\u2019Connell MB, Madden DM, Murray AM, Heaney RP, Kerzner LJ. Effects of proton pump inhibitors on calcium carbonate absorption in women: a randomized crossover trial. Am J Med. 2005;118(7):778-781. doi:10.1016\/j.amjmed.2005.02.007"},{"issue":"9","key":"ref8","series-title":"Int J Environ Res Public Health","first-page":"1571","article-title":"Proton pump inhibitors and fracture risk: a review of current evidence and mechanisms involved","volume":"16","author":"Thong BKS","year":"2019","unstructured":"Thong BKS, Ima-Nirwana S, Chin K-Y. Proton pump inhibitors and fracture risk: a review of current evidence and mechanisms involved. Int J Environ Res Public Health. 2019;16(9):1571. doi:10.3390\/ijerph16091571"},{"issue":"29","key":"ref9","series-title":"Equine Vet J","first-page":"59","article-title":"Effect of omeprazole paste on gastric acid secretion in horses","volume":"29","author":"Daurio CP","year":"1999","unstructured":"Daurio CP, Holste JE, Andrews FM,  Effect of omeprazole paste on gastric acid secretion in horses. Equine Vet J. 1999;29(29):59-62. doi:10.1111\/j.2042-3306.1999.tb05171.x"},{"key":"ref10","series-title":"J Equine Vet Sci","first-page":"102851","article-title":"Omeprazole reduces calcium digestibility in Thoroughbred horses","volume":"86","author":"Pagan JD","year":"2020","unstructured":"Pagan JD, Petroski-Rose L, Mann A, Hauss A. Omeprazole reduces calcium digestibility in Thoroughbred horses. J Equine Vet Sci. 2020;86:102851. doi:10.1016\/j.jevs.2019.102851"},{"issue":"11","key":"ref11","series-title":"Anim Prod Sci","first-page":"2263","article-title":"Omeprazole and its impact on mineral absorption in horses","volume":"57","author":"Nielsen BD","year":"2017","unstructured":"Nielsen BD, Eckert SM, Robison CI,  Omeprazole and its impact on mineral absorption in horses. Anim Prod Sci. 2017;57(11):2263-2269. doi:10.1071\/AN17323"},{"issue":"9","key":"ref12","series-title":"J Equine Vet Sci","first-page":"714","article-title":"Short-term omeprazole use does not affect serum calcium concentrations and bone density in horses","volume":"35","author":"Caston SS","year":"2015","unstructured":"Caston SS, Fredericks DC, Kersh KD, Wang C. Short-term omeprazole use does not affect serum calcium concentrations and bone density in horses. J Equine Vet Sci. 2015;35(9):714-723. doi:10.1016\/j.jevs.2015.07.003"},{"issue":"41","key":"ref13","series-title":"Equine Vet J","first-page":"80","article-title":"Treatment with histamine-type 2 receptor antagonists and omeprazole increase the risk of diarrhoea in neonatal foals treated in intensive care units","volume":"44","author":"Furr M","year":"2012","unstructured":"Furr M, Cohen ND, Axon JE,  Treatment with histamine-type 2 receptor antagonists and omeprazole increase the risk of diarrhoea in neonatal foals treated in intensive care units. Equine Vet J. 2012;44(41):80-86. doi:10.1111\/j.2042-3306.2011.00499.x"},{"issue":"2","key":"ref14","series-title":"Equine Vet J","first-page":"356","article-title":"Impact of concurrent treatment with omeprazole on phenylbutazone-induced equine gastric ulcer syndrome (EGUS)","volume":"53","author":"Ricord M","year":"2021","unstructured":"Ricord M, Andrews FM, Y\u00f1iguez FJM,  Impact of concurrent treatment with omeprazole on phenylbutazone-induced equine gastric ulcer syndrome (EGUS). Equine Vet J. 2021;53(2):356-363. doi:10.1111\/evj.13323"},{"issue":"29","key":"ref15","series-title":"Equine Vet J","first-page":"63","article-title":"Safety of omeprazole paste in foals and mature horses","volume":"29","author":"Plue RE","year":"1999","unstructured":"Plue RE, Wall HG, Daurio C, Attebery DK, Cox JL, Wallace DH. Safety of omeprazole paste in foals and mature horses. Equine Vet J. 1999;29(29):63-66. doi:10.1111\/j.2042-3306.1999.tb05172.x"},{"issue":"3","key":"ref16","series-title":"Equine Vet J","first-page":"424","article-title":"Fractures in Thoroughbred racing and the potential for pre-race identification of horses at risk","volume":"56","author":"Wright I","year":"2024","unstructured":"Wright I, Minshall G, Young N, Riggs C. Fractures in Thoroughbred racing and the potential for pre-race identification of horses at risk. Equine Vet J. 2024;56(3):424-436. doi:10.1111\/evj.14046"},{"issue":"2","key":"ref17","series-title":"J Vet Intern Med","first-page":"1111","article-title":"Incidence, recurrence, and outcome of postrace atrial fibrillation in Thoroughbred horses","volume":"35","author":"Nath LC","year":"2021","unstructured":"Nath LC, Elliott AD, Weir J, Curl P, Rosanowski SM, Franklin S. Incidence, recurrence, and outcome of postrace atrial fibrillation in Thoroughbred horses. J Vet Intern Med. 2021;35(2):1111-1120. doi:10.1111\/jvim.16063"},{"issue":"3","key":"ref18","series-title":"Equine Vet J","first-page":"339","article-title":"Exercise-induced pulmonary haemorrhage: a progressive disease affecting performance?","volume":"47","author":"Robinson NE","year":"2015","unstructured":"Robinson NE, Williams KJ, Stack A, Jackson WF, Derksen FJ. Exercise-induced pulmonary haemorrhage: a progressive disease affecting performance? Equine Vet J. 2015;47(3):339-340. doi:10.1111\/evj.12412"},{"issue":"6","key":"ref19","series-title":"Int J Epidemiol","first-page":"1887","article-title":"Robust causal inference using directed acyclic graphs: the R package \u2018dagitty\u2019","volume":"45","author":"Textor J","year":"2016","unstructured":"Textor J, van der Zander B, Gilthorpe MS, Liskiewicz M, Ellison GT. Robust causal inference using directed acyclic graphs: the R package \u2018dagitty\u2019. Int J Epidemiol. 2016;45(6):1887-1894. doi:10.1093\/ije\/dyw341"},{"issue":"6","key":"ref20","series-title":"Equine Vet J","first-page":"789","article-title":"Description of the incidence, clinical presentation and outcome of proximal limb and pelvic fractures in Hong Kong racehorses during 2003-2014","volume":"49","author":"McGlinchey L","year":"2017","unstructured":"McGlinchey L, Hurley MJ, Riggs CM, Rosanowski SM. Description of the incidence, clinical presentation and outcome of proximal limb and pelvic fractures in Hong Kong racehorses during 2003-2014. Equine Vet J. 2017;49(6):789-794. doi:10.1111\/evj.12696"},{"issue":"3","key":"ref21","series-title":"Eur J Clin Pharmacol","first-page":"365","article-title":"Use of acid-suppressive drugs and risk of fracture in children and young adults: a meta-analysis of observational studies","volume":"78","author":"Yang J","year":"2022","unstructured":"Yang J, Zhou TJ, Yang J, Bao DN. Use of acid-suppressive drugs and risk of fracture in children and young adults: a meta-analysis of observational studies. Eur J Clin Pharmacol. 2022;78(3):365-373. doi:10.1007\/s00228-021-03245-3"},{"issue":"10","key":"ref22","series-title":"Osteoporos Int","first-page":"2501","article-title":"Use of proton pump inhibitors is associated with fractures in young adults: a population-based study","volume":"26","author":"Freedberg DE","year":"2015","unstructured":"Freedberg DE, Haynes K, Denburg MR,  Use of proton pump inhibitors is associated with fractures in young adults: a population-based study. Osteoporos Int. 2015;26(10):2501-2507. doi:10.1007\/s00198-015-3168-0"},{"key":"ref23","series-title":"Front Pharmacol","first-page":"363","article-title":"Proton pump inhibitors and serum magnesium levels in patients with torsades de pointes","volume":"9","author":"Lazzerini PE","year":"2018","unstructured":"Lazzerini PE, Bertolozzi I, Finizola F,  Proton pump inhibitors and serum magnesium levels in patients with torsades de pointes. Front Pharmacol. 2018;9:363. doi:10.3389\/fphar.2018.00363"},{"issue":"7","key":"ref24","series-title":"Circ Arrhythm Electrophysiol","first-page":"e010042","article-title":"Proton pump inhibitors directly block hERG-potassium channel and independently increase the risk of QTc prolongation in a large cohort of US veterans","volume":"14","author":"Lazzerini PE","year":"2021","unstructured":"Lazzerini PE, Cartocci A, Qu YS,  Proton pump inhibitors directly block hERG-potassium channel and independently increase the risk of QTc prolongation in a large cohort of US veterans. Circ Arrhythm Electrophysiol. 2021;14(7):e010042. doi:10.1161\/CIRCEP.121.010042"},{"issue":"4","key":"ref25","series-title":"Equine Vet J","first-page":"422","article-title":"A comparison between pre- and post exercise administration of omeprazole in the treatment of equine gastric ulcer syndrome: a blinded, randomised, clinical trial","volume":"46","author":"Sykes BW","year":"2014","unstructured":"Sykes BW, Sykes KM, Hallowell GD. A comparison between pre- and post exercise administration of omeprazole in the treatment of equine gastric ulcer syndrome: a blinded, randomised, clinical trial. Equine Vet J. 2014;46(4):422-426. doi:10.1111\/evj.12083"},{"issue":"7","key":"ref26","series-title":"Am J Vet Res","first-page":"1123","article-title":"Exercise-induced pulmonary hemorrhage in Thoroughbreds after racing and breezing","volume":"43","author":"Raphel CF","year":"1982","unstructured":"Raphel CF, Soma LR. Exercise-induced pulmonary hemorrhage in Thoroughbreds after racing and breezing. Am J Vet Res. 1982;43(7):1123-1127. doi:10.2460\/ajvr.1982.43.07.1123"},{"issue":"3","key":"ref27","series-title":"Equine Vet J","first-page":"366","article-title":"Descriptive analysis of longitudinal endoscopy for exercise-induced pulmonary haemorrhage in Thoroughbred racehorses training and racing at the Hong Kong Jockey Club","volume":"47","author":"Preston SA","year":"2015","unstructured":"Preston SA, Riggs CM, Singleton MD, Troedsson MHT. Descriptive analysis of longitudinal endoscopy for exercise-induced pulmonary haemorrhage in Thoroughbred racehorses training and racing at the Hong Kong Jockey Club. Equine Vet J. 2015;47(3):366-371. doi:10.1111\/evj.12326"},{"issue":"8","key":"ref28","series-title":"Circulation","first-page":"845","article-title":"Unexpected effect of proton pump inhibitors: elevation of the cardiovascular risk factor asymmetric dimethylarginine","volume":"128","author":"Ghebremariam YT","year":"2013","unstructured":"Ghebremariam YT, LePendu P, Lee JC,  Unexpected effect of proton pump inhibitors: elevation of the cardiovascular risk factor asymmetric dimethylarginine. Circulation. 2013;128(8):845-853. doi:10.1161\/CIRCULATIONAHA.113.003602"},{"issue":"3","key":"ref29","series-title":"Physiol Rev","first-page":"731","article-title":"Nitric oxide in health and disease of the respiratory system","volume":"84","author":"Ricciardolo FLM","year":"2004","unstructured":"Ricciardolo FLM, Sterk PJ, Gaston B, Folkerts G. Nitric oxide in health and disease of the respiratory system. Physiol Rev. 2004;84(3):731-765. doi:10.1152\/physrev.00034.2003"},{"issue":"3","key":"ref30","series-title":"J Appl Physiol","first-page":"1097","article-title":"Stress failure of pulmonary capillaries in racehorses with exercise-induced pulmonary hemorrhage","volume":"75","author":"West JB","year":"1993","unstructured":"West JB, Mathieu-Costello O, Jones JH,  Stress failure of pulmonary capillaries in racehorses with exercise-induced pulmonary hemorrhage. J Appl Physiol. 1993;75(3):1097-1109. doi:10.1152\/jappl.1993.75.3.1097"},{"issue":"10","key":"ref31","series-title":"Thorax","first-page":"1034","article-title":"Nitric oxide and lung disease","volume":"48","author":"Barnes PJ","year":"1993","unstructured":"Barnes PJ, Belvisi MG. Nitric oxide and lung disease. Thorax. 1993;48(10):1034-1043. doi:10.1136\/thx.48.10.1034"},{"issue":"3","key":"ref32","series-title":"J Appl Physiol","first-page":"1210","article-title":"Ventilatory responses of the horse to exercise: effect of gas collection systems","volume":"63","author":"Bayly WM","year":"1987","unstructured":"Bayly WM, Schultz DA, Hodgson DR, Gollnick PD. Ventilatory responses of the horse to exercise: effect of gas collection systems. J Appl Physiol. 1987;63(3):1210-1217. doi:10.1152\/jappl.1987.63.3.1210"},{"issue":"12","key":"ref33","series-title":"Circ Res","first-page":"e36","article-title":"Proton pump inhibitors accelerate endothelial senescence","volume":"118","author":"Yepuri G","year":"2016","unstructured":"Yepuri G, Sukhovershin R, Nazari-Shafti TZ, Petrascheck M, Ghebre YT, Cooke JP. Proton pump inhibitors accelerate endothelial senescence. Circ Res. 2016;118(12):e36-e42. doi:10.1161\/CIRCRESAHA.116.308807"}],"container-title":["Journal of the American Veterinary Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/avmajournals.avma.org\/view\/journals\/javma\/264\/11\/javma.26.04.0319.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/avmajournals.avma.org\/downloadpdf\/journals\/javma\/264\/11\/javma.26.04.0319.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/avmajournals.avma.org\/downloadpdf\/journals\/javma\/264\/11\/javma.26.04.0319.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:25:24Z","timestamp":1792171524000},"score":1,"resource":{"primary":{"URL":"https:\/\/avmajournals.avma.org\/view\/journals\/javma\/264\/11\/javma.26.04.0319.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,11,1]]},"references-count":33,"journal-issue":{"issue":"11"},"URL":"https:\/\/doi.org\/10.2460\/javma.26.04.0319","relation":{},"ISSN":["0003-1488"],"issn-type":[{"value":"0003-1488","type":"print"}],"subject":[],"published":{"date-parts":[[2026,11,1]]}}}