Document Detail


Selection of patients for successful maintenance treatment of esophagitis with low-dose omeprazole: use of 24-hour gastric pH monitoring.
MedLine Citation:
PMID:  10685738     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Treating patients with erosive esophagitis and maintaining remission in a cost-effective fashion is a desirable goal in clinical practice. There are no established criteria to identify patients with healed esophagitis who will subsequently remain in remission with low-dose omeprazole therapy. We investigated whether 24-h esophageal-gastric pH monitoring could provide criteria to select patients for low-dose omeprazole maintenance therapy. METHODS: Seventy consecutive symptomatic outpatients with grade 2-3 reflux esophagitis were prospectively investigated. They were treated with 20 mg/day omeprazole for 2 months. Those with healed esophagitis were given alternate-evening 20-mg omeprazole maintenance therapy for 6 months. Clinical evaluation, endoscopy, and 24-h esophageal-gastric pH were done at the end of each treatment period. Results of pH studies of patients in remission were compared with those with endoscopically documented relapse of esophagitis. RESULTS: In 63/70 patient (intention-to-treat, 90%; 95% confidence interval [CI], 83-97%) esophagitis was healed at 2 months. During the 6-month maintenance period esophagitis remain healed in 28 (G1) (40%; 95% CI, 29-52%), but recurred in 32 patients (G2). During healing with omeprazole 20 mg/day the 24-h gastric pH was below 4 for <10% of the time in 96% of the patients, who subsequently remained in long-term remission with low-dose maintenance therapy (G1), but not in any patient with recurrence of esophagitis (G2). The 10% threshold value has a specificity of 1.00 and sensitivity of 0.96. CONCLUSIONS: The 24-h intragastric pH monitoring during 20 mg/day omeprazole therapy provides criteria by which to preselect patients with reflux esophagitis who will remain in remission with low-dose omeprazole therapy.
Authors:
S D Ladas; P S Tassios; S A Raptis
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  95     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2000 Feb 
Date Detail:
Created Date:  2000-03-08     Completed Date:  2000-03-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  374-80     Citation Subset:  IM    
Affiliation:
Second Department of Internal Medicine, Evangelismos Hospital, Athens University, Greece.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Confidence Intervals
Enzyme Inhibitors / administration & dosage,  therapeutic use*
Esophagitis, Peptic / drug therapy,  prevention & control*
Esophagoscopy
Female
Follow-Up Studies
Humans
Hydrogen-Ion Concentration
Logistic Models
Male
Middle Aged
Monitoring, Ambulatory*
Omeprazole / administration & dosage,  therapeutic use*
Patient Selection*
Prospective Studies
Recurrence
Remission Induction
Sensitivity and Specificity
Stomach / physiopathology*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Enzyme Inhibitors; 73590-58-6/Omeprazole
Comments/Corrections
Comment In:
Am J Gastroenterol. 2000 Feb;95(2):337-8   [PMID:  10685730 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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