Standard-dose lansoprazole is more effective than high-dose ranitidine in achieving endoscopic healing and symptom relief in patients with moderatelysevere reflux oesophagitis

Background: In the treatment of reflux oesophagitis, H-2-receptor antagonis ts are still widely used in spite of the apparent higher efficacy of proton pump inhibitors. In an attempt to compensate for the lower efficacy, H-2-r eceptor antagonists are now increasingly being used at a higher dose. Objective: To assess whether or not standard-dose lansoprazole (30 mg o.d.) is more effective than high-dose ranitidine (300 mg b.d.) in moderately se vere reflux oesophagitis (grades II-III). Methods: Lansoprazole or ranitidine was given to 133 patients for 4-8 weeks in a double-blind, randomized, parallel group, multicentre trial. Results: The percentage of patients with endoscopically-verified healing wa s significantly higher on lansoprazole than on ranitidine both after 4 week s (79% vs. 42%) and 8 weeks (91% vs. 66%), though smoking had a negative im pact on oesophagitis healing with lansoprazole. Heartburn, retrosternal pai n and belching improved significantly better with lansoprazole than with ra nitidine, as did the patient-rated overall symptom severity. Relief of hear tburn appeared somewhat faster with ranitidine, but was more pronounced wit h lansoprazole. The number of patients with adverse events was similar in b oth treatment groups. Conclusion: Standard-dose lansoprazole is better than high-dose ranitidine in moderately severe reflux oesophagitis.