HISTAMINE H-2-RECEPTOR ANTAGONIST-REFRACTORY ESOPHAGITIS - THE EFFICACY OF LONG-TERM OMEPRAZOLE MAINTENANCE TREATMENT

Background. Erosive oesophagitis refractory to high dose histamine H-2 receptor antagonists (definition: failure to heal fully after greater than or equal to 3 months' treatment with cimetidine 3.2 g or ranitid ine 0.9 g) responds well to omeprazole 40 mg daily but frequently rela pses when the patients are put back on maintenance H-2 receptor antago nists at medium or even high dose (e.g. cimetidine 1.6 g and 3.2 g, re spectively). Aim. To investigate the efficacy of maintenance omeprazol e 20 mg daily in refractory erosive oesophagitis. Patients & Methods. In this open, sequential study, patients with H-2 receptor antagonist- refractory, oesophagitis were healed on omeprazole 40 mg daily and the n put on maintenance H-2 receptor antagonists (cimetidine 1.6 g or 3.2 g). Relapses were re-treated with omeprazole 40 mg; upon rehealing, p atients were put on maintenance omeprazole 20 mg daily for up to 4.5 y ears. Results. Healing on omeprazole occurred in 38 out of 39 patients (97%) at 12 weeks. Only six of the 38 patients (16%) relapsed (asympt omatic in half) during subsequent maintenance treatment, whereas all h ad relapsed earlier on high dose H-2 receptor antagonists. Conclusion. Within the limits of interpretation of an open study, omeprazole 20 m g daily seems effective in maintaining prolonged remission in this gro up of patients with H-2 receptor antagonist-refractory oesophagitis.