Heartburn, treatment in primary care: randomised, double blind study for 8 weeks

Objective To compare the effects and tolerability of omeprazole and cisapride with that of placebo for control of heartburn in primary care patients. Design Randomised, double blind, placebo controlled study. Setting 65 primary care practices in Norway. Participants 483 untreated patients with complaints of heartburn greater than or equal to 3 days a week, with at most grade 1 reflux oesophagitis. Interventions Omeprazole 20 mg once daily, cisapride 20 mg twice daily, or placebo for 8 weeks. Main outcome measures Adequate central of heartburn, defined as less than or equal to 1 day of the past 7 days with no more chan mild heartburn after 4 weeks of treatment. Results In the all patients treated analysis, adequate control of heartburn was achieved in 71%, of patients taking omeprazole, 22% taking cisapride, and 18% caking placebo after 4 weeks of treatment (omeprazole v cisapride and placebo, P < 0.0001; cisapride v placebo, non-significant). Results were comparable in patients with or without reflux oesophagitis. In patients treated with omeprazole only, symptom control aas achieved significantly more often in patients positive for Helicobacter pylori. Antacid use was 2-3 times greater in patients taking cisapride or placebo than in those taking omeprazole. Relief of non-reflux symptoms did not significantly differ between the three groups. Significantly more patients ticking cisapride reported adverse events than those taking omeprazole or placebo. Conclusions Omeprazole 20 mg once daily was highly effective in relieving heartburn whereas cisapride 20 mg twice daily was not significantly more effective than placebo.