Long‐term lansoprazole treatment for gastro‐oesophageal reflux disease: clinical efficacy and influence on gastric mucosa

Abstract

INTRODUCTIONAlthough Helicobacter pylori is probably not implicated in the pathogenesis of re¯ux oesophagitis, usually onethird to one-half of adult patients with re¯ux oesophagitis or endoscopy-negative re¯ux disease are infected with H. pylori.1 This ®gure is comparable with the prevalence of the infection in the same age group. 2 Two major patterns of H. pylori infection have been recognized: the low acid route, with pangastritis, atrophy and metaplasia, and the elevated acid route, with antral gastritis and duodenal ulcer. 3 The low acid route is believed to give rise to an increased risk of cancer. 3Atrophy and intestinal metaplasia are long-term sequelae of H. pylori infection. 4,5 They are considered to be important precursors for gastric carcinoma.6±8 Type I (complete Ð small intestinal type) and type II (incomplete Ð sialomucin-containing goblet cells scattered among gastric-type neutral mucin-secreting cells) metaplasia are believed to carry the lowest risk. Type III metaplasia (incomplete form, with goblet cells secreting SUMMARY Background: Long-term acid suppression is believed to accelerate atrophic gastritis in Helicobacter pyloripositive patients. The in¯uence of long-term therapy with lansoprazole has not been examined. Aim: To study the clinical and endoscopic ef®cacy and histological evolution of gastric mucosa during 5 years of maintenance treatment with lansoprazole, 30 mg. Methods: Seventy-eight patients with endoscopically proven oesophagitis were followed for 5 years. Biopsies taken at the start of the study, during follow-up and after 5 years were available for 73 patients. Results: The total endoscopic relapse rate was 14.1%. At the start of the study, 34 patients were Helicobacter pylori negative and 39 were Helicobacter pylori positive (two atrophy, 25 antral gastritis, 12 pangastritis). At

Safety and Efficacy of Long-Term Maintenance Therapy with Oral Dose of Rabeprazole 10 mg Once Daily in Japanese Patients with Reflux Esophagitis

“…Long-standing hypergastremia resulting from the potent gastric acid-suppressing action of PPI is believed to be a major factor in this, because gastrin might have a trophic effect on gastric mucosal cells (7). Considering those concerns, many clinical studies involving the long-term administration of PPI for several years have been conducted in Europe and the US, confirming the absence of problems in terms of tolerability (8)(9)(10)(11). However, collecting evidence on the safety and tolerability of long-term PPI treatment in Japanese patients with RE may be extremely important in terms of the future usability of PPI due to the high prevalence of H. pylori infection rate in elderly patients in Japan (12,13), and also based on the fact that a high prevalence of RE patients are also elderly individuals (14,15).…”

Changes of gastric histology in patients with erosive oesophagitis receiving long‐term lansoprazole maintenance therapy

“…PPI therapy, as opposed to therapy with histamine‐2 receptor antagonists, has been shown to be the preferred long‐term management strategy for EO, because of the superior efficacy profile of these agents 7, 10 . Lansoprazole is a well‐established PPI and its efficacy, safety and tolerability in preventing relapse in patients with EO are supported by an extensive body of literature 5–7, 11–15 …”

Proton Pump Inhibitors and Helicobacter pylori Gastritis: Friends or Foes?

“…Most of these studies were uncontrolled. Several of them confirmed that a proportion of H. pylori ‐positive patients develop atrophic gastritis within the first years of proton pump inhibitor treatment (Eissele et al 1997; Klinkenberg‐Knol et al 2000; Geboes et al 2001; Lamberts et al 2001; Rindi et al 2005). There were however also a number of negative studies, which either did not find any atrophy development at all, or only in very low frequency (Meining et al 1998a & b; Stolte et al 1998; Genta et al 2003).…”