It is questionable whether a symptomatic condition with few serious medical consequences requires proton pump inhibitor (PPI) treatment.
If effective, a less-potent treatment may be preferable.
Drs Juul-Hansen and Rydning from Norway compared an H2-blocker in an effervescent formulation with a PPI in on-demand treatment of endoscopy-negative gastro-esophageal reflux disease (GERD).
Included were patients with heartburn and/or acid regurgitation for at least 3 months duration, a negative endoscopy and a positive response to 7 days of lansoprazole 60 mg daily.
Following pH-metry, the patients were randomized to receive either ranitidine effervescent tablets 75 mg or lansoprazole capsules 15 mg to a maximum of 4 per day on-demand.
|The average number of tablets per day was 1 with lansoprazole|
|Alimentary Pharmacology & Therapeutics|
The numbers taken were registered monthly for 6 months.
If treatment was unsuccessful (lack of efficacy or side effects), patients were registered as failures.
The research team evaluated 103 patients, of which 63 were considered for statistical analysis.
The team assessed 32 patients on lansoprazole, and 31 on ranitidine.
The researchers noted that 55% on ranitidine, and 13% on lansoprazole failed.
The average number of tablets per day was 1 in the lansoprazole group, and 3 in the ranitidine group.
Dr Juul-Hansen’s team concludes, “On-demand treatment in patients with endoscopy-negative GERD gives a high success rate with a fairly low dose of PPI.”
“The H2-blocker had significantly less success, however, almost half were satisfied with the treatment.”