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Preventing Relapse in Reflux Oesophagitis

The expectation has been that healing active oesophagitis would produce a lasting remission by interrupting the vicious cycle of events where the oesophagitis further impairs the acid-reflux mechanism. Unfortunately most patients suffer relapse within a few weeks of stopping acid-suppressant treatment.

So if patients need to take long term treatment, which is best?

Best long-term treatment?

A recent randomised double-blind study in Gut sought to answer that. Patients with oesophagitis were treated with omeprazole, and only those with healing entered the RCT. Treatments were either daily omeprazole (20 mg every morning), omeprazole 20 mg every weekend morning (three days a week), or ranitidine 150 mg twice daily.

There were over 50 patients in each group, and they were assessed for relapse by endoscopy (with gastric biopsy) at 6 and 12 months or in the event of symptom recurrence. Histopathology was graded blind at the end of the study and all three groups had similar demographics at randomisation.

There were many analyses in the complex study which involved histopathology as well as laboratory investigations. The simple result was that patients taking daily omeprazole had significantly fewer relapses than those taking omeprazole at weekends, or those taking daily ranitidine. The figures at 12 months (censored for drop-outs) are shown below.

They show that after one year of treatment 89% of those taking daily omeprazole were free of oesophagitis, compared with 32% taking weekend omeprazole and 25% of those taking daily ranitidine.

Reference:

J Dent, ND Yeomans, M Mackinnon, W Reed, FM Narielvala, DJ Hetzel, E Solcia, DJC Shearman. Omeprazole v ranitidine for prevention of relapse in reflux oesophagitis. A controlled double blind trial of their efficacy and safety. Gut 1994 35: 590-8.



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