The role of omeprazole in healing and prevention of reflux disease

Abstract

Reflux esophagitis differs from peptic ulcer disease in many respects. Whereas nighttime acid inhibition alone achieves healing in approximately 80 to 90% of patients with peptic ulcer, more profound acid inhibition seems to be necessary in those with GERD. Conventional dosing with H2-receptor antagonists has been successful in only about 50% of the patients with reflux esophagitis. Strong, prolonged 24-hour inhibition of gastric acid secretion is probably the most important factor in the treatment of reflux esophagitis. Omeprazole, a substituted benzimidazole, produces effective 24-hour inhibition on gastric acid secretion. In doses ranging from 20-60 mg once daily, omeprazole has proved to be effective in the short-term treatment of reflux esophagitis, even in patients resistant to treatment with H2-receptor antagonists. Healing of severe, resistant reflux esophagitis therefore is no longer a clinical problem. Reflux esophagitis is a chronic, relapsing condition that cannot be compared to peptic ulcer disease in all aspects. In particular, long-term therapy must be more aggressive than the standard minimum maintenance dose used in peptic ulcer. Not only for healing, but also for prevention of recurrences, strong, prolonged inhibition of acid secretion must be provided. Experience of more than 5 years of continuous treatment with omeprazole, in doses adjusted to prevent recurrences, has demonstrated the high efficacy of this agent in the long-term management of reflux patients. Omeprazole provided the long-standing, strong acid inhibition that is so important in treating this condition. Long-term treatment with omeprazole in patients with resistant reflux disease did induce an initial rise of serum gastrin levels, two to four times the pre-entry value.(ABSTRACT TRUNCATED AT 250 WORDS)