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
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).