| Long-term treatment with omeprazole for refractory reflux esophagitis: efficacy and safety. | |
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MedLine Citation:
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PMID: 8017742 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To evaluate the long-term efficacy and safety of omeprazole in patients with gastroesophageal reflux disease resistant to treatment with histamine-2 (H2)-receptor antagonists. DESIGN: Cohort analytic study with a mean follow-up of 48 months (range, 36 to 64 months). SETTING: Patients receiving ambulatory care from referral centers. PATIENTS: 91 patients with gastroesophageal reflux disease resistant to treatment with an H2-receptor antagonist but subsequently responsive to 40 mg of omeprazole daily. INTERVENTION: Open maintenance therapy consisting of 20 mg of omeprazole daily in 86 patients and 40 mg daily in 5 patients. OUTCOME MEASURES: Endoscopy to assess healing; side effects, laboratory values, fasting serum gastrin level, and gastric corpus biopsies to assess safety. RESULTS: Esophagitis recurred in 47% of the patients receiving 20 mg of omeprazole daily, but all rehealed after the dose was doubled. Seven of 40 patients (18%) had a second relapse after a mean follow-up time of 24 months (range, 9 to 36 months) that was successfully treated with a further 20-mg dose increment for a mean period of 36 months (range, 6 to 39 months). Median gastrin levels increased initially from 60 ng/L before study entry to 162 ng/L (P < 0.01) with treatment and reached a plateau during maintenance treatment. Very high gastrin levels (> 500 ng/L) were observed in a subgroup (11%) of patients. The incidence of micronodular hyperplasia increased from 2.5% of the patients at first biopsy to 20% at the last biopsy (P = 0.001), with a corresponding progression of gastritis to subatrophic or atrophic gastritis from less than 1% to 25% (P < 0.001), which was more pronounced in patients with very high serum gastrin levels. CONCLUSIONS: Maintenance therapy with omeprazole was effective for at least 5 years in patients with gastroesophageal reflux disease resistant to treatment with H2-receptor antagonists. Treatment was accompanied by a persistent increase in serum gastrin levels and an increase of micronodular argyrophil cell hyperplasia and subatrophic or atrophic gastritis. |
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Authors:
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E C Klinkenberg-Knol; H P Festen; J B Jansen; C B Lamers; F Nelis; P Snel; A Lückers; C P Dekkers; N Havu; S G Meuwissen |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Annals of internal medicine Volume: 121 ISSN: 0003-4819 ISO Abbreviation: Ann. Intern. Med. Publication Date: 1994 Aug |
Date Detail:
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Created Date: 1994-07-26 Completed Date: 1994-07-26 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 161-7 Citation Subset: AIM; IM |
Affiliation:
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Free University Hospital, Department of Gastroenterology, Amsterdam, the Netherlands. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Barrett Esophagus
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drug therapy Drug Resistance Esophagitis, Peptic / blood, drug therapy*, pathology Female Gastrins / blood Gastroscopy Humans Life Tables Male Omeprazole / administration & dosage, adverse effects, therapeutic use* Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Gastrins; 73590-58-6/Omeprazole |
| Comments/Corrections | |
Comment In:
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Ann Intern Med. 1994 Aug 1;121(3):232-3
[PMID:
8017751
]
Ann Intern Med. 1995 Feb 1;122(3):236; author reply 236-7 [PMID: 7888009 ] Ann Intern Med. 1995 Feb 1;122(3):236; author reply 236-7 [PMID: 7810947 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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