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

Abstract

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.

Efficacy of a Potassium-Competitive Acid Blocker for Improving Symptoms in Patients with Reflux Esophagitis, Non-Erosive Reflux Disease, and Functional Dyspepsia

“…PPIs have been used as the first-line drugs for the treatment of GERD in Japan since it became evident from the results of multiple Japanese studies, and those from outside Japan, that PPIs exhibit superior protective effects against the esophageal mucosal injury associated with RE compared with those of histamine-2 receptor antagonists (4,15). However, it has become clear during the use of PPIs in patients with GERD that there are certain cases in which GERD symptoms remain following treatment with PPIs (16).…”

Review: Causes of, and therapeutic approaches for, proton pump inhibitor-resistant gastroesophageal reflux disease in Asia

“…In addition, they are able to heal over 90% of mucosal breaks detected by endoscopy in patients with reflux esophagitis [Soga et al 1999]. Nevertheless, 20% of patients continue to complain of troublesome reflux symptoms and 10% have mucosal breaks during continuous PPI administration.…”

Heartburn issues burnt out?

“…There are data showing that an H2RA was as effective as a PPI for mild RE in patients with positive H. pylori status, but the H2RA was less effective in mild RE in patients without H. pylori. 15 Because acid secretion after the eradication of H. pylori is restored to a level comparable to that in H. pylori-negative subjects, the acid suppression exerted by H2RAs may be inadequate to control RE after the eradication of H. pylori. Another reason for the inefficient control exercised by H2RAs after the eradication of H. pylori may be the development of tolerance to these agents after the eradication of H. pylori.…”