The role of proton pump inhibitors in the treatment of gastro‐oesophageal reflux disease
- 1 April 1995
- journal article
- research article
- Published by Wiley in Alimentary Pharmacology & Therapeutics
- Vol. 9 (s1) , 15-25
- https://doi.org/10.1111/j.1365-2036.1995.tb00779.x
Abstract
Efficacy (healing, symptom relief) and cost-effectiveness are the principal reasons for the rapidly increasing use of proton pump inhibitors (PPIs) for the management of gastro-oesophageal reflux disease. Mean healing rates pooled from clinical trials are as follows: on omeprazole (OME) 20 mg vs. H2-receptor antagonist. H2RA (cimetidine (CIM) 1.6 g or ranitidine (RAN) 300 mg) (eight studies) at 4 weeks, 67% vs. 37%: at 8 weeks, 81% vs. 49%: on lansoprazole (LAN) 30 mg vs. H2RA (three studies), 83% vs. 47% and 91% vs. 63% at 4 and 8 weeks, respectively. The benefit is greatest in severe disease because the H2RAs are disproportionately less effective. Heartburn is more rapidly relieved and in a higher proportion: at 4 weeks, on OME 20 mg vs. H2RA. 77% vs. 47% and on LAN 30 mg vs. H2RA, 81% vs. 46%. Both PPIs are effective in H2RA-refractory disease, approximately 80% healing occurring in 8 weeks. Relapse rates after healing vary from 25% to 85% at 6 months. Maintenance therapy sustains remissions: relapse at 1 year is, on OME 20 mg vs. RAN 300 mg (2 studies), 12% vs. 79%, and 28% vs. 55% (and 38% on OME 10 mg); on LAN 30 mg vs. 10 mg vs. RAN 600 mg, 20% vs. 31% vs. 68%. The effectiveness of the lower dose allows for dose titration. The higher drug costs for the PPIs are offset by their higher efficacy, making their use cost effective, particularly in severe disease. Efficacy and cost effectiveness are likely to further expand the use of PPIs at the expense of H2RAs as increasing numbers of patients with milder disease are treated.Keywords
This publication has 32 references indexed in Scilit:
- Rolling review: gastro‐oesophageal reflux diseaseAlimentary Pharmacology & Therapeutics, 1993
- Clinical and Economic Factors in the Selection of Drugs for Gastroesophageal Reflux DiseasePharmacoEconomics, 1993
- Lansoprazole versus Omeprazole in Short-Term Treatment of Reflux Oesophagitis Results of a Scandinavian Multicentre TrialScandinavian Journal of Gastroenterology, 1993
- Assessing the Cost-effectiveness of Medical Treatments in Acid-related Diseases: The Markov Chain Approach Applied to a Comparison between Intermittent and Maintenance Treatment of Reflux EsophagitisScandinavian Journal of Gastroenterology, 1993
- Ranitidine for erosive oesophagitis: a double-blind, placebo-controlled studyAlimentary Pharmacology & Therapeutics, 1992
- Effect of Cisapride on Relapse of Reflux Oesophagitis, Healed with an Antisecretory DrugScandinavian Journal of Gastroenterology, 1992
- Healing and prevention of relapse of reflux oesophagitis by cisapride.Gut, 1991
- Prevention of Relapse of Reflux Oesophagitis after Endoscopic Healing: The Efficacy and Safety of Omeprazole Compared with RanitidineDigestion, 1990
- Omeprazole (40 mg) is superior to ranitidine in short-term treatment of ulcerative reflux esophagitisDigestive Diseases and Sciences, 1988