Comparison of omeprazole and cimetidine in reflux esophagitis: symptomatic, endoscopic, and histological evaluations

Article Abstract:

Reflux esophagitis is a condition in which gastric acid enters the lower portion of the esophagus, causing inflammation and destruction of the mucosal lining of the esophagus. This is painful, and can lead to a variety of serious consequences. Treatment for this disorder is sometimes in the form of drugs that suppress gastric acid secretion, such as cimetidine and omeprazole. It has been reported that omeprazole may be superior to other compounds in treating several gastric acid-related disorders. To compare the efficacy of omeprazole and cimetidine in healing the inflammation associated with reflux esophagitis, 274 patients with endoscopically verified reflux esophagitis were randomly assigned to receive either omeprazole (once daily) or cimetidine (four times daily) in standard dosages. After four weeks, 56 percent of the patients receiving omeprazole showed healing of the esophagitis, whereas this was only noted in 26 percent of those receiving cimetidine. Eight weeks after commencement of treatment, these values were 71 for the omeprazole group, and 35 percent for the cimetidine group. A subset of patients was subjected to biopsy (removal of small amounts of tissue from the affected portion of the esophagus for microscopic analysis). The proportion of patients who entered the study with abnormal biopsy results who were normal following treatment was 67 percent in the omeprazole group and 48 percent in the cimetidine group. Omeprazole significantly reduced the intake of over-the-counter antacids compared with cimetidine. When groups were corrected for patient compliance (the four-times-daily cimetidine dosing regimen was more likely to be broken), omeprazole still offered a therapeutic advantage over cimetidine. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Physiological aspects

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Combination of cimetidine and alginic acid: an improvement in the treatment of oesophageal reflux disease

Article Abstract:

Esophageal reflux disease, known as heartburn in its mild form, is a condition that afflicts up to 10 percent of the population on a daily basis. Continued reflux of gastric acid into the esophagus can lead to esophagitis (chronic inflammation of the esophagus) and increased risk for other esophageal disease. A goal of treatment is to control the pain and damage done by acid in the esophagus. Two treatments are commonly used for esophageal reflux disease. The administration of alginic acid provides a physical barrier to the acid by producing a thick, foamy viscous coating in the esophagus. Histamine H2 receptor blockers, such as cimetidine, reduce the secretion of gastric acid by parietal cells in the stomach. Inasmuch as these two strategies work through different, complementary, mechanisms to reduce acid-induced damage, accompanying administration might be expected to be considerably more effective than either alone. To evaluate this, the efficacy of a new chewable tablet containing both cimetidine (half the usual dose) and alginic acid was compared with that of the standard dose of cimetidine in a group of 424 patients who were randomly assigned to receive one or the other treatment at 35 treatment centers in England, Ireland, and Holland. Treatment continued for 12 weeks. Of the original 424 patients, 312 had data suitable for complete analysis. Sixty-three percent of the patients receiving combination therapy completed the 12 weeks without the need to increase the dosage of cimetidine. Symptom improvement was significantly greater in the group receiving combination therapy. There were no significant differences between the two groups in the rate of healing or the appearance of esophagitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Combination, Combination drug therapy, Hydrocolloid surgical dressings, Heartburn, Esophagitis

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Double blind comparison of omeprazole (40 mg od) versus cimetidine (400 mg qd) in the treatment of symptomatic erosive reflux esophagitis, assessed endoscopically, histologically, and by 24 h pH monitoring

Article Abstract:

During swallowing, a wave of muscular relaxation and contraction (peristalsis) propels ingested substances toward the junction of the esophagus and stomach (gastroesophageal junction), where a transient relaxation of the gastroesophageal sphincter muscle permits the material to enter the stomach, which relaxes to accommodate the increased volume. Closure of the sphincter prevents reflux of the highly acidic gastric contents back into the esophagus, where it could cause the inflammatory condition known as reflux esophagitis. One form of drug treatment for reflux esophagitis involves the administration of drugs that suppress gastric acid secretion. Treatment with histamine H2 receptor blockers, which are quite effective in the treatment of gastric and duodenal ulcers caused by excessive gastric acidity, is not very effective in cases of gastroesophageal reflux. Omeprazole, a drug that suppresses gastric acidity by interfering with a key step in the secretion of acid from gastric cells, was compared with cimetidine (a histamine H2 blocker) in 67 patients who were randomly assigned to receive the recommended dosages of either cimetidine or omeprazole for an eight-week period. Patients were assessed at four and eight week intervals after they began treatment. Omeprazole administered once daily produced more rapid and profound relief of symptoms, healing, and reduction of esophageal acid exposure than did cimetidine administered four times daily. (Consumer Summary produced by Reliance Medical Information, Inc.)

Stomach, Gastric juice

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