Healing and relapse of severe peptic esophagitis after treatment with omeprazole

Hetzel, David J.; Dent, John; Reed, W. D.; Narielvala, F. M.; Mackinnon, Malcolm; McCarthy, Justin H.; Mitchell, B.; Beveridge, B. R.; Laurence, B. H.; Gibson, Geoffrey G.; Grant, A. Kerr; Shearman, D. J. C.; Whitehead, R.; Buckle, P. J.

doi:10.1016/0016-5085(88)90162-x

Cited by 734 publications

(334 citation statements)

References 34 publications

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“…Numerous studies have shown that the severity of re¯ux oesophagitis has a major in¯uence on the outcome of short-term therapy. 13±18 However, similar studies of the risk of relapse after cessation of treatment, 14,17 or during maintenance treatment, have shown con¯icting results regarding the importance of the severity of oesophagitis as a predictor for relapse. 28,29,40,41 This was therefore a major focus of our analysis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors influencing relapse of oesophagitis during maintenance therapy with antisecretory drugs: a meta‐analysis of long‐term omeprazole trials

Carlsson

Galmiche

Lundell

et al. 1997

Aliment Pharmacol Ther

131

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Background: This meta‐analysis investigated factors that may affect the risk of relapse of oesophagitis, and evaluated the predictive value of symptoms for the presence of relapse during long‐term treatment. Methods: Individual data from 1154 patients included in five independently conducted, randomized, long‐term clinical trials of the efficacy of different dosage regimens of omeprazole, standard ranitidine treatment and placebo for the prevention of relapse of oesophagitis were pooled for this meta‐analysis. The therapeutic regimens studied were omeprazole 20 mg o.m. (OME20) in 366 patients, omeprazole 10 mg o.m. (OME10) in 225 patients, omeprazole 20 mg weekends (OMEW) in 235 patients, ranitidine 150 mg b.d. (RAN) in 179 patients, or placebo (PLA) in 149 patients. Results: OME20 maintained 82.4% (95% CI: 78.2–86.6%) of patients in endoscopic remission over the 6‐month period compared to 71.9% (95% CI: 65.5–78.3%) for OME10, 52.3% (95% CI: 44.4–60.1%) for RAN, 42.7% (95% CI: 35.8–49.5%) for OMEW, and 10.6% (95% CI: 5.0–16.3%) for PLA. A Cox's regression analysis of time to recurrence of oesophagitis showed that four factors were associated with a higher relapse rate during placebo and active maintenance therapy: (a) pre‐treatment severity of oesophagitis (P<0.0001), (b) young age (P=0.01), (c) non‐smoking (P=0.02) and (d) moderate/severe regurgitation before entry into the trials (P=0.03). Asymptomatic relapse of oesophagitis was uncommon, being found in only 8.6% of the patients. Conclusions: Maintenance treatment with omeprazole 10 and 20 mg daily is superior to all other regimens tested, and is only marginally influenced by the pre‐treatment severity of oesophagitis. Age contributes to the factors that influence the outcome during long‐term treatment with omeprazole. Symptom relief is highly predictive for the maintenance of healing.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors influencing relapse of oesophagitis during maintenance therapy with antisecretory drugs: a meta‐analysis of long‐term omeprazole trials

Carlsson

Galmiche

Lundell

et al. 1997

Aliment Pharmacol Ther

131

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“…Once healing with omeprazole has been accomplished, cessation of treatment in patients with severe or refractory esophagitis will result in relapse of esophagitis in more than 80% of all cases within 6 months (6,8). Maintenance treatment with H2-receptor antagonists is not likely to prevent relapse (31).…”

Section: Cost Effectiveness Of Omeprazole In the Maintenance Phasementioning

confidence: 99%

Cost Effectiveness of Medical versus Surgical Treatment in Patients with Severe or Refractory Gastroesophageal Reflux Disease in The Netherlands

Boom

Hameeteman

et al. 1996

Scandinavian Journal of Gastroenterology

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“…Oesophagitis was graded based on the scoring system developed by Hetzel and colleagues. 19 A hiatus hernia was diagnosed if during quiet respirations gastric folds were seen extending at least 2 cm above the diaphragmatic hiatus.…”

Section: Endoscopymentioning

confidence: 99%

Temporal associations between coughing or wheezing and acid reflux in asthmatics

Avidan¹,

Sonnenberg²,

Schnell³

et al. 2000

Am J Gastroenterology

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Background and aims-The pulmonary symptoms of patients with lung disease may be ascribed to gastro-oesophageal reflux although a causal relationship between acid reflux and coughing or wheezing has not been proved. Does cough cause reflux or does reflux cause cough? The aim of this study was to evaluate 24 hour oesophageal pH tracings of asthmatics with gastro-oesophageal reflux to determine the temporal association between acid reflux and coughing or wheezing. Methods-The oesophageal tracings of 128 asthmatics from the outpatient clinics who underwent oesophagogastroduodenoscopy, oesophageal manometry, and 24 hour oesophageal pH monitoring were analysed. Three possible temporal relationships between the occurrence of acid reflux and the occurrence of coughs or wheezes were evaluated: (1) pulmonary symptoms preceding reflux; (2) reflux preceding pulmonary symptoms; and (3) unrelated occurrence of both events. Results-Of 128 asthmatics, 53 recorded five or more coughs and 19 recorded three or more wheezes during the 24 hour recording period. Mean acid contact time was similar in asthmatics with and without pulmonary symptoms (12.2 (1.2)% v 10.4 (0.6)%). Of all coughs and wheezes, 46% and 48%, respectively, were associated with acid reflux. For the individual asthmatic, the likelihood of reflux induced coughing increased as the number of coughs increased. Conclusions-Half of all coughs and wheezes in asthmatics are associated with acid reflux into the oesophagus. While an occasional coughing episode can lead to reflux, it is rather the reflux episode in the vast majority of instances that leads to cough. (Gut 2001;49:767-772)

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Healing and relapse of severe peptic esophagitis after treatment with omeprazole

Cited by 734 publications

References 34 publications

Prognostic factors influencing relapse of oesophagitis during maintenance therapy with antisecretory drugs: a meta‐analysis of long‐term omeprazole trials

Prognostic factors influencing relapse of oesophagitis during maintenance therapy with antisecretory drugs: a meta‐analysis of long‐term omeprazole trials

Cost Effectiveness of Medical versus Surgical Treatment in Patients with Severe or Refractory Gastroesophageal Reflux Disease in The Netherlands

Temporal associations between coughing or wheezing and acid reflux in asthmatics

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