Dr Lundell's findings, published in the August issue of the European Journal of Gastroenterology and Hepatology, indicate that proton pump inhibitor therapy and surgery are both highly effective strategies for the management of GERD.
310 patients with erosive esophagitis were enrolled in the study: 155 were randomized to omeprazole maintenance treatment and 155 were allocated to open anti-reflux surgery.
139 of the surgery group and 129 of the omeprazole group completed 3 years of follow-up.
97 patients in the surgical group remained in remission for the follow-up period, compared with 77 of the patients allocated omeprazole therapy.
These figures seem to suggest an increased failure rate for omeprazole therapy. Dr Lundell points out that when the dose of omeprazole was regularly adjusted according to patient symptoms, the failure rates of the two therapies were not significantly different.
"Adjust the dose of omeprazole to optimize GERD therapy."
Dr Lars Lundell.
In a clinical situation, the dose of omeprazole is likely to be adjusted. Dr Lundell suggests varying the daily dose of omeprazole between 20mg and 60mg, depending on the severity of symptoms.