Treatment of Reflux Oesophagitis with H₂-Receptor Antagonists

Abstract

The important therapeutic value of H₂-receptor antagonists for the treatment of patients with reflux oesophagitis has been demonstrated beyond doubt. A large number of patients have been treated with cimetidine or ranitidine in controlled as well as open short-term studies. Mild to moderately severe reflux oesophagitis heals effectively when H₂-receptor antagonists are prescribed for a sufficient time period, preferentially 12 weeks. The more severe forms of oesophagitis, however, need more profound acid suppression, with potent H₂-receptor antagonists, addition of prokinetic agents, or treatment with H+/K + ATP-ase antagonists. Omeprazole has proven to be of high efficacy, particularly in the management of severe reflux oesophagitis. Data on long-term treatment with H₂-receptor antagonists, to prevent recurrences after healing, are not reassuring: long-term low-dose H₂-receptor antagonist therapy is not effective, and trials should be undertaken with higher doses of H₂-receptor antagonists, more potent antagonists, or with combinations of antagonists and prokinetics. In these studies, 24-h intraoesophageal and intragastric pH measurements should be incorporated, to detect more accurately time periods of non-suppressed acid secretion. Such studies will undoubtedly better define the therapeutic place of the presently available and forthcoming H₂-receptor antagonists.

Key Words:

• Cimetidine
• cisapride
• long-term treatment
• omeprazole
• ranitidine
• H₂-receptor antagonist
• reflux oesophagitis
• short-term treatment
• sucralfate
• 24-h pH registration