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

Abstract

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.

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015

“…Among GERD patients, affirmative PPI maintenance therapy is mandatory to control patients with severe erosive GERD, because it is liable to recur without such therapy [98,99].…”

Chronic Gastroesophagitis Treated Successfully with Novel Taping Therapy: A New Approach to the Treatment of Digestive Disorders

“…Based on this knowledge and the fact that there were remaining painful responses in the chest and abdomen in spite of marked disappearance of the main symptoms, we tried to remove all symptoms as completely as possible, with focusing at the left painful responses, particularly since symptom relief is highly predictive for the maintenance of healing [5]. Finally, the stabilization and reduction of the patient's radial pulse from 78 to less than 70 per min correlated with the resolution of his presenting symptoms.…”

“…Medications are commonly used for the treatment, however many patients continue to suffer from this condition [5]. While gastritis and esophagitis can occur separately, there are patients with chronic disease who may present with both conditions Since these diseases are not easily treated with medications alone, the possible use of a nonchemical therapy is worthy of formal study.…”

Comparative study of Omeprazole, Rabeprazole and Ilaprazole for their efficacy in patient suffering from reflux esophagitis with symptoms.

“…inhibition of the histamine receptor on the basolateral membrane(H2-blockers) and (2) proton pump specific drugs targeted against the H+K+ATPase(proton pump inhibitors) [7,8 ]. Both of these therapies have greatly improved the quality of life for patients suffering from this disease;however,there is an ever increasing number of patients that have experienced recurrent disease while still taking the drugs [9 ].It has been estimated that about 30% of gastroesophageal reflux disease patients remain symptomatic on the standard dose of PPI [10 ]. One explanation relates to the fact that typically PPIs have a short plasma half life, which often lead to nocturnal acid breakthrough.…”