OMEPRAZOLE VERSUS H2-RECEPTOR ANTAGONISTS IN TREATING PATIENTS WITH PEPTIC STRICTURE AND ESOPHAGITIS

Background/Aims: Although dysphagia in patients with peptic stricture is attributed to a decreased luminal diameter, coexistent esophagitis may be an equally important cause. The goals of this study were to det ermine whether medical healing of esophagitis in patients with strictu re improves dysphagia and decreases dilatation need and to compare the efficacy and cost-effectiveness of omeprazole versus H-2-receptor ant agonists (H-2RA). Methods: Thirty-four dysphagic patients with peptic stricture and erosive esophagitis were dilated and randomized to omepr azole 20 mg every day versus H-2RA (ranitidine 150 mg twice daily or f amotidine 20 mg twice daily). Patients received further dilatations on ly if dysphagia frequency was greater than or equal to once per week. At 3 and 6 months, patients were assessed for esophagitis healing, dys phagia relief, and bougienage requirements. Cost-effectiveness of omep razole and H-2RA was determined. Results: Patients with healed esophag itis at 3 and 6 months were more likely to be dysphagia-free and to re quire fewer dilatations than patients with persistent esophagitis. At 6 months, omeprazole produced a significantly (P < 0.01) higher rate o f esophagitis healing, dysphagia relief, and fewer dilatations compare d with H-2RA. Omeprazole was also 40%-50% more cost-effective. Conclus ions: Esophagitis healing improves dysphagia and decreases dilatation need in patients with peptic stricture. Omeprazole heals esophagitis a nd relieves dysphagia more efficaciously than H-2RA while decreasing c osts to patients.