Therapeutic Options in Severe Reflux Oesophagitis

Abstract

Standard doses of H₂-receptor antagonists are usually effective in milder forms of reflux oesophagitis, but these lower doses induce relatively low healing rates in more severe forms of the disease. In the patients with severe reflux oesophagitis, prokinetic or mucosa-protecting agents do not offer better results, whereas a combination of standard doses of H₂-receptor antagonists with prokinetic or mucosa-protecting agents results in no or only marginally better results than obtained with H₂-receptor antagonist mono-therapy. Several studies have shown that insufficient inhibition of gastric acid secretion is the major reason for the low healing rates obtained with standard doses of H₂-receptor antagonists. It has recently been shown that higher doses of ranitidine increase the time the oesophageal pH is above 4 and induce higher healing rates in patients with severe reflux oesophagitis. Therefore, we now have three therapeutic options for patients with severe reflux oesophagitis: first, higher doses of histamine H₂-receptor antagonists; secondly, omeprazole; and thirdly, antireflux surgery.

Key Words:

• Anti-reflux surgery
• gastric acid inhibition
• H₂-receptor antagonists
• omeprazole
• ranitidine
• reflux oesophagitis