Healing and Relapse of Reflux Esophagitis During Treatment With Ranitidine

Koelz, H. R.; Birchler, R; Bretholz, Adam; Bron, B; Capitaine, Y; Delmore, Geoffrey; Fehr, H. F.; Fumagalli, I.; Gehrig, John D.; Gonvers, Jean‐Jacques; Halter, F; Hammer, Bruce E.; Kayasseh, L; Kobler, E; Miller, G.; Münst, G; Pelloni, S; Réalini, S; Schmid, P. Ch.; Voirol, M; Blum, A. L.

doi:10.1016/s0016-5085(86)80017-8

Cited by 193 publications

(49 citation statements)

References 18 publications

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“…maintenance after successful treatment, ranitidine has been found to be no better than placebo, 8,9 whereas at 6 months relapse rates of 39% and 41% were observed with omeprazole, compared to 89% and 94% with placebo. 10,11 Similarly, omeprazole was superior to ranitidine in maintenance treatment for 1 year.…”

Section: Introductionmentioning

confidence: 99%

One‐year prophylactic efficacy and safety of pantoprazole in controlling gastro‐oesophageal reflux symptoms in patients with healed reflux oesophagitis

Mössner

Koop²,

Porst

et al. 1997

Aliment Pharmacol Ther

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Background:Pantoprazole is a benzimidazole derivative which selectively inhibits the proton pump H+, K+‐ATPase necessary for the final step in gastric acid secretion.Aim:To investigate the tolerability and the prophylactic effect of pantoprazole 40 mg once daily on relapse in patients whose reflux oesophagitis had been healed.Methods:The safety of pantoprazole 40 mg once daily was assessed in an open 1‐year trial on 222 patients whose reflux oesophagitis had been healed with omeprazole or pantoprazole. Relapse was defined as endoscopically‐confirmed reflux oesophagitis (at least Grade I), with endoscopies being performed for patients experiencing 3 consecutive days of disease‐specific symptoms.Results:Kaplan–Meier survival analysis at 6 and 12 months gave estimated treatment failure rates of 2% and 6% from confirmed relapses (per‐protocol), and of 9% and 30% for a worst‐case group (all withdrawals counted as failures). The only population shift in laboratory variables was a doubling of the median serum gastrin level over the first 6 months; thereafter it stabilized. Fifty‐four (24%) patients experienced adverse events; 15 of these withdrew. Serious adverse events were reported for 12 patients.Conclusions:Pantoprazole appears to be highly effective and to have a good safety profile for long‐term prophylaxis of reflux oesophagitis.

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Section: Introductionmentioning

confidence: 99%

One‐year prophylactic efficacy and safety of pantoprazole in controlling gastro‐oesophageal reflux symptoms in patients with healed reflux oesophagitis

Mössner

Koop²,

Porst

et al. 1997

Aliment Pharmacol Ther

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“…23 Other predictors for relapse of re¯ux oesophagitis identi®ed were: use of omeprazole to heal oesophagitis, late symptom relief, high grade of re¯ux oesophagitis and no active therapy. 23 In studies with H 2 -receptor antagonists, residual symptoms at the time of healing signi®cantly predicted relapse of re¯ux oesophagitis during maintenance therapy, 24,25 but baseline symptoms do not seem to have been studied. In a maintenance study with omeprazole 10 or 20 mg daily, symptoms before starting therapy was found to be of prognostic importance for relapse of re¯ux oesophagitis.…”

mentioning

confidence: 99%

Prognostic factors for relapse of reflux oesophagitis and symptoms during 12 months of therapy with lansoprazole

Hatlebakk

Berstad

1997

Aliment Pharmacol Ther

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Background:Symptom relief and endoscopic healing are both important treatment goals in patients with reflux oesophagitis. Knowledge of predictive factors for treatment success could facilitate choice of treatment in individual patients.Aim:To assess the value of clinical data and data from baseline ancillary investigations in predicting the outcome of maintenance therapy with a proton pump inhibitor.Methods:After healing and symptom relief had been obtained on open therapy with lansoprazole 30 mg daily, 103 patients with reflux oesophagitis grade 1 or 2 were randomized to maintenance therapy with lansoprazole 15 or 30 mg daily, and time until recurrence of symptoms and/or endoscopic changes was recorded. The predictive value of the following variables was assessed by Cox regression analysis: dose of lansoprazole, symptom severity, grade of reflux oesophagitis, Helicobacter pylori infection status, lower oesophageal sphincter resting tone, percentage of 24 h with an oesophageal pH of <4.0, and median 24 h intragastric pH before start of treatment.Results:Dose of lansoprazole (P = 0.01) and symptom severity (P < 0.05) both significantly predicted time to relapse. Grade of reflux oesophagitis had only a borderline predictive value (P = 0.09), while H. pylori infection status and data from manometry and intraoesophageal 24‐hour pH‐metry did not predict relapse.Conclusions:Symptom severity before starting therapy is a significant predictive factor for treatment success during potent antisecretory therapy with lansoprazole, more so than endoscopic grade of reflux oesophagitis. In a group of patients with uncomplicated reflux oesophagitis being considered for maintenance therapy with lansoprazole, ancillary investigations with endoscopy, manometry and 24‐hour pH‐metry gave very limited prognostic information. H. pylori infected patients relapsed as early as patients who were not infected.

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“…It has been shown that in this subgroup, maintenance therapy with PPIs prevents relapse, 16 and alternative agents such as H2RAs or prokinetic agents may not be effective. 4,6,17 As the population with erosive esophagitis represents only a minority of all patients with GERD, 18 we wished to evaluate a more inclusive population representative of patients managed in a primary care setting. The primary goal of this study was to determine the feasibility of step-down therapy in patients with symptoms of GERD rendered asymptomatic with PPIs.…”

Section: Background and Aimsmentioning

confidence: 99%

Step-Down Management Of Gastroesophageal Reflux Disease

&NA;

2001

European Journal of Gastroenterology & Hepatology

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Background & Aims:As the economic burden of gastroesophageal reflux disease (GERD) is largely weighted to maintenance as opposed to initial therapy, switching from more potent to less expensive medication once symptoms are alleviated (step-down therapy) may prove to be most cost-effective. This study aimed to prospectively evaluate the feasibility of step-down therapy in a cohort of patients with symptoms of uncomplicated GERD. Methods: Patients whose GERD symptoms were alleviated by proton pump inhibitors (PPIs) were recruited from outpatient general medicine clinics. After baseline demographic and quality of life information were obtained, PPIs were withdrawn from subjects in a stepwise fashion. Primary outcome was recurrence of symptoms during follow-up that required reinstitution of PPIs. Secondary outcomes included changes in quality of life and overall cost of management. Predictors of nonresponse to step-down were assessed. Results: Seventy-one of 73 enrolled subjects completed the study. Forty-one of 71 (58%) were asymptomatic off PPI therapy after 1 year of follow-up. Twenty-four of 71 (34%) required histamine 2-receptor antagonists, 5/71 (7%) prokinetic agents, 1/71 (1%) both, and 11/71 (15%) remained asymptomatic without medication. Quality of life did not significantly change, whereas management costs decreased by 37%. Multivariable analysis revealed younger age and a dominant symptom of heartburn to predict PPI requirement. Conclusions:Step-down therapy is successful in the majority of patients and can decrease costs without adversely affecting quality of life.

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Healing and Relapse of Reflux Esophagitis During Treatment With Ranitidine

Cited by 193 publications

References 18 publications

One‐year prophylactic efficacy and safety of pantoprazole in controlling gastro‐oesophageal reflux symptoms in patients with healed reflux oesophagitis

One‐year prophylactic efficacy and safety of pantoprazole in controlling gastro‐oesophageal reflux symptoms in patients with healed reflux oesophagitis

Prognostic factors for relapse of reflux oesophagitis and symptoms during 12 months of therapy with lansoprazole

Step-Down Management Of Gastroesophageal Reflux Disease

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