Gastroesophageal Reflux Disease: Acute and Maintenance Treatments with Cimetidine

Abstract

The comparative efficacy of a 12-week acute treatment with 800 and 1600 mg cimetidine daily and the effectiveness of a 400-mg single-dose maintenance treatment versus placebo lasting 6 months were studied in a double-blind fashion in 30 and 24 patients, respectively, with gastroesophageal reflux (GER) disease. Cimetidine in a dose of 800 or 1600 mg daily resulted in a significant symptomatic improvement and a decrease in the extent of endoscopic esophagitis. An improvement in the gastroesophageal sphincter function during treatment was suggested by a significant decrease in the frequency of reflux, as evaluated by isotope scintigraphy. No significant differences were found between the two doses of cimetidine. The overall initial improvement tended to be maintained during maintenance treatment, but no significant differences were found between cimetidine and placebo. The present study thus supports the use of 800 mg of cimetidine daily for short-term treatment of GER disease but provides no support for maintenance treatment with a low dose. The study further suggests that cimetidine treatment, by reducing the tendency to GER, may induce long-lasting remission of the disease.

Three year follow up of patients with gastrooesophageal reflux disease.

“…Another study analysed a six months maintenance treatment with cimetidine or placebo in 24 patients. 17 Sustained symptomatic relief was similar in both groups when only patients were considered who completed the observation period. Because four of 10 patients in the placebo group dropped out because of worsening symptoms, their data are therefore in accordance with our results.…”

Healing and prevention of relapse of reflux oesophagitis by cisapride.

“…Maintenance with H2 receptor antagonists, at doses lower than those given for acute curative treatment (ranitidine 150 mg once a day, famotidine 20-40 mg once a day, cimetidine 400-800 mg twice a day), has not been shown to be efficacious in preventing symptom or endoscopic relapse compared with placebo. [12][13][14][15][16][17][18][19][20][21] Similarly, one study with omeprazole showed that for patients to remain in remission a dose of 40 mg once a day had to be giventhat is, the dose given in the acute healing phase.22 However, prolonged treatment with omeprazole has not been adequately assessed either for efficacy or for safety.323 To date, one paper has suggested that prophylaxis of relapse may be achieved with the full therapeutic dose of ranitidine. 28 Our study provides the first evidence for the efficacy of a prokinetic drug to maintain remission in patients with oesophagitis.…”

Gastroesophageal reflux and asthma: a review of pathogenesis, diagnosis, and therapy

“…The lowest recommended dose for each drug is as follows: cimetidine, 400 mg; ranitidine, 150 mg; famotidine, 20 mg; and nizatidine, 150 mg, twice daily for 6–12 weeks. These regimens produced healing in 17–70% and improvement of symptoms in 32–82% of patients (94–106). Rates of improvement of 45–75% have been reported with high doses of H 2 ‐receptor antagonists (cimetidine, 800 mg; ranitidine, 300 mg; famotidine, 40 mg; nizatidine, 300 mg; all twice daily) (91, 103, 123).…”