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H2-Receptor Antagonist's Effectiveness in Patients with Reflux Related Erosive Esophagitis (a long term clinical study)

MOHAMMAD FARIVAR, NORWOOD HOSPITAL, ONE LENOX STREET, NORWOOD, MA 02062

This study was undertaken in order to evaluate the effectiveness of continuous long-term H2 receptor blockade in healing esophageal mucosal disruption in patients with reflux esophagitis.

Materials & Methods: The office records of 70 consecutive patients seen with erosive esophagitis were retrospectively reviewed. In addition to bland diet, elevation of head of bed, and use of antacid as necessary, treatment was begun with the usual dose of H2 receptor antagonists (ranitidine 150mg p.o. bid or its equivalent). All patients were seen every 3-4 months and endoscoped periodically. During each follow up visit, medications were adjusted up to a maximum dose of ranitidine 300mg tid, plus prokinetics, metoclopramide or cisapride (10mg qid) and sucralfate (1g qid), in order to make patients asymptomatic, and/or to heal mucosal disruption.

Results: There were 34 female patients (28-82 yr. old, average 57) and 36 males (31-75 yr. old, average 54), 14 smoked, 11 used ethanol. 269 EGD's were done (2-12/patient, average 3.9). Combined follow up time was 386 patient years or 4,632 months (10-166 months per patient, average 67 months). In 7 patients (10%) with mild grade I esophagitis (Savary-Miller Classification), erosions healed with the usual dose of H2 receptor antagonists. In 4 more patients (6%) mucosal lesions healed with increasing dose of H2 receptor antagonists (equivalent of 300 mg ranitidine tid). The addition of prokinetic alone had no effect, but when combined with sucralfate healed erosions in 2 more patients (3%). 54 patients (77%) continued to have erosive esophagitis in spite of continuous long term treatment with H2 receptor antagonists and prokinetics and sucralfate. On subsequent follow up, four patients on the usual dose of H2 receptor antagonists for heartburn developed erosive esophagitis, 2 patients developed Schatzki's Ring and one developed adenocarcinoma of the esophagus.

Conclusion: In this group of patients with erosive reflux esophagitis, long term use of H2 receptor antagonists healed mucosal disruption in only 16% of the patients (grade 1 and 2).

 

 

 

 

 

         This is an educational site created by M. Farivar, M.D. The information provided is the author's opinion based on years of clinical experience and research.  You are advised to consult your own physician about the applicability of this information to your particular needs.  Also, keep in mind that symptom response to therapy does not preclude the presence of more serious conditions. 

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