Proton pump inhibitors in acute healing and maintenance of erosive or worse esophagitis: a systematic overview

Abstract

The aim of this paper is to present a systematic overview of the efficacy of the proton pump inhibitors (PPI), omeprazole and the newer lansoprazole, in the healing and maintenance of erosive or worse (grade II to IV) esophagitis. At the time of the 1996 gastroesophageal reflux disease (GERD) consensus meeting, a third PPI, pantoprazole, was not yet available in Canada and was, therefore, not discussed. The present review is therefore restricted to patients with more severe disease than that of the average patient who presents to the family physician with symptoms of mild GERD. In these patients with endoscopic evidence of damaged esophageal mucosa, both proton pump inhibitors were highly effective and safe in acute healing of erosive esophagitis and were significantly better than H2 receptor antagonists, healing faster and much more completely, with shorter durations of treatment. Suggested initial doses were omeprazole 20 mg once daily and lansoprazole 30 mg once daily, which were consistent with the manufacturer's recommendations. Once patients with this degree of esophagitis have their mucosal lesions healed, they almost inevitably have recurrence of esophagitis (80% at one year) unless some form of maintenance therapy is continued. Unfortunately, for these patients with healed erosive or ulcerative esophagitis, H2 receptor antagonists appear to be no better than placebo, and a PPI is the only class of drug able to minimize relapse significantly.