Is a proton pump inhibitor necessary for the treatment of lower-grade reflux esophagitis?

• Published in: Journal of gastroenterology 1999-08, Vol.34 (4), p.435-440
• Main Authors: Soga, T, Matsuura, M, Kodama, Y, Fujita, T, Sekimoto, I, Nishimura, K, Yoshida, S, Kutsumi, H, Fujimoto, S
• Format: Article
• Language: English
• Subjects: Alcohol Drinking - adverse effects; Case-Control Studies; Endoscopy, Digestive System; Enzyme Inhibitors - therapeutic use; Esophagitis, Peptic - drug therapy; Famotidine - therapeutic use; Female; Follow-Up Studies; Helicobacter pylori - isolation & purification; Histamine H2 Antagonists - therapeutic use; Humans; Male; Middle Aged; Omeprazole - therapeutic use; Prospective Studies; Proton Pump Inhibitors; Remission Induction; Treatment Outcome
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s005350050292

The efficacy of histamine H2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) therapies in healing reflux esophagitis was compared in a prospective randomized case-control comparative study. A total of 71 patients with grade A to D esophagitis (Los Angeles classification) were given either famotidine 20 mg twice a day (Fam; n = 35) or omeprazole 20 mg once daily (Ome; n = 36) for 8 weeks. Endoscopy was performed to assess healing in 57 patients. Healed patients were followed-up without H2RA or PPI therapy for 3 months. At the end of follow-up, endoscopy was able to be performed in 33 patients. Healing rates for patients in the Fam and Ome groups were 58.6% (17/OFF and 97.4% (27/28), respectively (P < 0.001), and when limited to grade A to B, healing rates were 60.9% (14/23) and 100% (25/25), respectively (P < 0.001). Concerning Helicobacter pylori infection, healing rates for the Fam and Ome groups in H. pylori (+) patients were 90.0% (9/10) and 90.9% (10/11), respectively (P = 1.00). Remission rates in the Fam and Ome groups were 45.0% (91/2)) and 33.3% (6/18), respectively (P > 0.4). In regard to alcohol drinking, remission rates of daily and social drinkers were 7.7% and 42.4%, respectively (P < 0.03). Thus, PPI should be the drug of choice even for healing lower-grade reflux esophagitis, especially in H. pylori (-) patients. Treatment with H2RA may be an alternative choice in H. pylori (+) patients. After healing, most patients cannot sustain remission without maintenance therapy.