A COMPARISON OF 5 MAINTENANCE THERAPIES FOR REFLUX ESOPHAGITIS

被引:442
作者
VIGNERI, S
TERMINI, R
LEANDRO, G
BADALAMENTI, S
PANTALENA, M
SAVARINO, V
DIMARIO, F
BATTAGLIA, G
MELA, GS
PILOTTO, A
PLEBANI, M
DAVI, G
机构
[1] HOSP S DE BELLIS, BARI, ITALY
[2] UNIV GENOA, DEPT INTERNAL MED, I-16126 GENOA, ITALY
[3] UNIV PADUA, DEPT GASTROENTEROL, I-35100 PADUA, ITALY
[4] HOSP VENICE, GASTROENTEROL & ENDOSCOPY UNIT, VENICE, ITALY
[5] HOSP SCHIO, GERIATR UNIT, VICENZA, ITALY
[6] UNIV CHIETI, DEPT MED, CHIETI, ITALY
关键词
D O I
10.1056/NEJM199510263331703
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Patients with reflux esophagitis have a high rate of relapse within one year after therapy is discontinued. Methods. We enrolled 175 adults with endoscopy-confirmed reflux esophagitis in a prospective study comparing five maintenance therapies. All the patients were initially treated with omeprazole (40 mg orally once a day) for four to eight weeks, and healing was confirmed by endoscopy. Participants were then stratified according to their initial grade of esophagitis and randomly assigned to 12 months of treatment with one of the following: cisapride (10 mg three times a day), ranitidine (150 mg three times a day), omeprazole (20 mg per day), ranitidine plus cisapride, or omeprazole plus cisapride. Endoscopy was repeated after 6 and 12 months of treatment; the endoscopists were blinded to the treatment assignments. Remission was defined as the absence of esophageal lesions on scheduled or unscheduled follow-up endoscopy. Results. In an intention-to-treat analysis, the numbers of patients in continued remission at 12 months were 19 of 35 (54 percent) in the cisapride group, 17 of 35 (49 percent) in the ranitidine group, 28 of 35 (80 percent) in the omeprazole group, 23 of 35 (66 percent) in the ranitidine-plus-cisapride group, and 31 of 35 (89 percent) in the omeprazole-plus-cisapride group. Omeprazole was significantly more effective than cisapride (P=0.02) or ranitidine (P=0.003), and combination therapy with omeprazole plus cisapride was significantly more effective than cisapride alone (P=0.003), ranitidine alone (P<0.001), or ranitidine plus cisapride (P=0.03). Ranitidine plus cisapride was significantly better than ranitidine alone (P=0.05). Conclusions. For maintenance treatment of reflux esophagitis, omeprazole alone or in combination with cisapride is more effective than ranitidine alone or cisapride alone, and the combination of omeprazole and cisapride is more effective than ranitidine plus cisapride.
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页码:1106 / 1110
页数:5
相关论文
共 23 条
  • [1] ARMITAGE P, 1987, STATISTICAL METHODS
  • [2] BARDIHAN KD, 1992, ADV DRUG THERAPY GAS, P246
  • [3] DENT J, 1990, AUG WORLD C GASTR SY
  • [4] DIXON WJ, 1992, BMDP STATISTICAL SOF
  • [5] GELDOF H, 1993, ALIMENT PHARM THERAP, V7, P409
  • [7] Harris EK, 1991, SURVIVORSHIP ANAL CL
  • [8] HEALING AND RELAPSE OF SEVERE PEPTIC ESOPHAGITIS AFTER TREATMENT WITH OMEPRAZOLE
    HETZEL, DJ
    DENT, J
    REED, WD
    NARIELVALA, FM
    MACKINNON, M
    MCCARTHY, JH
    MITCHELL, B
    BEVERIDGE, BR
    LAURENCE, BH
    GIBSON, GG
    GRANT, AK
    SHEARMAN, DJC
    WHITEHEAD, R
    BUCKLE, PJ
    [J]. GASTROENTEROLOGY, 1988, 95 (04) : 903 - 912
  • [9] JANISCH HD, 1988, HEPATO-GASTROENTEROL, V35, P125
  • [10] JOELSON, 1992, DIGESTION, V53, P213