THE MANAGEMENT OF ACID-RELATED DYSPEPSIA IN GENERAL-PRACTICE - A COMPARISON OF AN OMEPRAZOLE VERSUS AN ANTACID-ALGINATE RANITIDINE MANAGEMENT STRATEGY/

Background: There is need for an evidence-based comparison of clinical management strategies to provide the rationale for selection of a par ticular therapeutic approach to treatment. Ideal dyspepsia treatment s hould quickly and conveniently alleviate patient symptoms whilst also minimizing the use of healthcare resources. Aim: To examine dyspepsia symptom relief over 16 weeks and compare an omeprazole clinical manage ment strategy with a commonly used combination of antacid-alginate fol lowed by H-2-antagonist. Methods: Seven hundred and twenty-five patien ts participated in this randomized, open, parallel group comparison ov er 16 weeks. Patients were randomized to receive either an omeprazole treatment strategy (363) consisting of omeprazole 10 mg stepping up to 20 mg and 40 mg as required, or an antacid-alginate/ ranitidine treat ment strategy (362) consisting of antacid-alginate 10 mL q.d.s. steppi ng up to ranitidine 150 mg b.d. and 150 mg q.d.s. as required. Results : A greater proportion of patients receiving the omeprazole clinical m anagement strategy had achieved the stringent health target of complet e symptom relief (61 vs. 40%, P < 0.0001) at 16 weeks. Forty-six per c ent of omeprazole-treated patients were symptom free after the first 1 0 mg step compared to only 17% in the antacid-alginate treated group ( P = 0.0001). Total relief of heartburn, the most common symptom at ent ry, was achieved by more patients in the omeprazole treatment group th an the antacid-alginate/ranitidine treatment group, 62 vs. 36%, respec tively, at 4 weeks, and 81 vs. 60% at 16 weeks (P = 0.0001), Conclusio n: Treatment with the omeprazole clinical management strategy was supe rior to the antacid-alginate/ranitidine management strategy in providi ng relief of acid-related dyspepsia symptoms after 16 weeks. In additi on, the omeprazole treatment strategy involved fewer GP consultations and thus minimized the use of other healthcare resources.