Esophageal reflux disease

Bixquert M. Maintenance therapy in gastro-esophageal reflux disease. Drugs. 2005 65(suppl l) 59-66. 

ZacnyJ, Zamakhshary M, Sketris I, et al. Systematic review the efficacy of intermittent and on-demand therapy with histamine H2-receptor antagonists or proton pump inhibitors for gastro-esophageal reflux disease patients. Aliment Pharmacol Ther. 2005 21 1299-1312. 

To assess symptom control, esomeprazole 20 mg on demand has been compared with placebo on demand (maximum of one dose a day) for 6 months in a multicenter, double-blind study in 342 endoscopy-negative patients with gastro-esophageal reflux disease (2). There was complete resolution of heartburn after 4 weeks of daily esomeprazole therapy. On-demand therapy with esomeprazole was significantly more effective than placebo in controlling symptoms. The frequencies of adverse effects and laboratory profiles were similar in the two groups when adjusted for the time spent in the study. 

Pantoprazole 20 mg/day and ranitidine 300 mg/day for 12 months have been compared in the relief of symptoms in a multicenter, randomized, double-blind trial in 307 patients with symptomatic gastro-esophageal reflux disease in primary care (3). Symptom control was significantly more effective and faster with pantoprazole than ranitidine. Adverse effects were similar in the two groups the most common adverse effects were headache, diarrhea, nausea, constipation, and vomiting. 

Pantoprazole 40 mg/day and pantoprazole 40 mg/day plus cisapride 20 mg bd for 8 weeks have been compared in the treatment of gastro-esophageal reflux disease in a multicenter, randomized, double-blind trial in 350 patients (4). The addition of cisapride did not significantly improve symptom control or healing rates. The frequency of adverse effects in the two groups was similar. Compliance was worse in the pantoprazole plus cisapride group. 

An unblinded questionnaire survey has been carried out to determine patients perceptions of differences in the efficacy, adverse effects, and value of omeprazole versus lansoprazole for gastro-esophageal reflux disease maintenance therapy (5). The patients had been taking omeprazole for at least 2 months and then switched to lansoprazole for a minimum of 2 months. There was no significant difference between median symptom scores with the two drugs, but 64% of patients preferred omeprazole to lansoprazole. The most commonly reported adverse effects with both drugs were flatulence, headache, and diarrhea. Significantly more patients reported adverse effects with lansoprazole than with omeprazole. 

To assess acid control, esomeprazole 20 or 40 mg/day has been compared with omeprazole 20 mg/day for 5 days in a double-blind, crossover study in 38 patients with symptoms of gastro-esophageal reflux disease (10). Pharmacokinetic variables and 24-hour intragastric pH were measured on day 5 of each dosing period. 

Omeprazole 40 mg/day for 6 weeks and lansoprazole 30 mg bd have been compared for sjmptom control in a randomized study in 96 patients with gastro-esophageal reflux disease who had earher failed to respond to lansoprazole 30 mg/day (14). The two drugs were equally effective in symptom control. There were no significant differences in adverse events between the two groups. The most frequent adverse events reported were diarrhea, abdominal pain/discomfort, bloating/gas, vomiting, and headache. 

Lansoprazole 15 or 30 mg/day and ranitidine 150 mg bd for 8 weeks have been compared in the treatment of non-erosive gastro-esophageal reflux disease in two double-bhnd, multicenter trials in 901 patients (27). Overall symptom control was significantly better with either dose of lansoprazole than with ranitidine or placebo. There was no significant difference in reported adverse events between the treatment groups. The more commonly reported were abdominal pain and diarrhea. 

An uncontrolled retrospective study of patients who had taken proton pump inhibitors for an average of 33 months found gastric polyps in 17 of 231 patients who underwent two or more endoscopies for complicated gastro-esophageal reflux disease (33). The polyps were generally small (under 1 cm), sessile, and multiple, and were present in the proximal or mid gastric body. Of the 15 polyps removed endoscopically, nine were fundic gland type, four were hyperplastic, and two were inflammatory. None had any dysplasia or carcinoma. 

In an open, multicenter trial in 2579 patients with erosive gastro-esophageal reflux disease, rabeprazole 20 mg/ day for 8 weeks relieved symptoms in most patients (in over 60% by day 1 and over 80% by day 7) (8). Rabeprazole was well tolerated, and the most common adverse effects were headache, diarrhea, abdominal pain, and nausea, each reported by under 2% of the patients. 

Different doses of ranitidine (150 mg bd and 300 mg bd for 8 weeks) have been compared in resolving heartburn in 271 patients with gastro-esophageal reflux disease who had been symptomatic after 6 weeks of therapy with ranitidine 150 mg bd (24). Less than 20% of the patients in either group had complete resolution of heartburn at 4 and 8 weeks there was no significant difference in the efficacy between the two treatment groups. At least one adverse event was reported by 38% of the patients in each group. They included sinusitis, nausea, abdominal pain, dyspepsia, constipation, and increased liver enzymes. 

First Multi-Disciplinary International Symposium on Supraesophageal Complications of Reflux Disease. R. Shaker, Guest Editor. American Journal of Medicine 103(5A), 1997 (The whole issue deals with gastrointestinal esophageal reflux disease). 

Metaanalysis of relapse rate ratios (RR) and 95% confidence intervals (Cl) for proton pump inhibitors compared with ranitidine or placebo after 6 months. (Adapted from Caro JJ, Salas M, Ward A. Healing and relapse rates in gastro-esophageal reflux disease. Clin Ther 2001 23 998-1017.)... 

Bais JE, Bartelsman JF, Bonjer HJ, et al. Laparoscopic or conventional Nissen fundoplication for gastro-esophageal reflux disease randomized clinical trial. Lancet 2000 355 170-174. 

Dent J. Roles of gastric acid and pH in the pathogenesis of gastro-esophageal reflux disease. Scand J Gastroenterol 1994 (Suppl 201) 55-61. 

Chapter 5 Intravenous Anti-Secretory Therapy Section 6 Gastro-Esophageal Reflux Disease... 

GU, gastric ulcer DU, duodenal ulcer GERD, gastro-esophageal reflux disease maint, maintenance therapy HP , Helicobacter / y/or/-positive, resp. negative vag X, vagotomy. 

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