Gastro-oesophageal reflux disease, which is experienced daily by a significant proportion of individuals, may result in serious sequelae such as erosive oesophagitis. Short-term treatment with
acid antisecretory
therapy (a
proton pump inhibitor or a
histamine H(2) receptor antagonist) is highly effective in healing the erosive oesophagitis lesion. However, numerous studies confirm that unless maintenance
therapy is initiated virtually all patients will experience oesophagitis relapse within 1 year, as well as an increasing severity of oesophagitis and risk for complications such as Barrett's oesophagus and
adenocarcinoma. Studies evaluating the efficacy of
proton pump inhibitor and H(2) antagonist maintenance
therapy have found that only the
proton pump inhibitors significantly reduce the incidence of oesophagitis relapse. Pharmacoeconomic studies have also confirmed that
proton pump inhibitor maintenance
therapy is cost effective, by virtue of the ability of these agents to reduce the incidence of relapse as well as prolong the time to relapse and increase the number of weeks per year that patients are without symptoms.
Lansoprazole, a member of the
proton pump inhibitor class of agents, has been extensively studied in the treatment of patients with a variety of
acid-related disorders. Among those with erosive oesophagitis, maintenance
therapy with
lansoprazole 15 or 30mg once daily is highly effective in preventing relapse. Studies have documented that
lansoprazole 15 and 30mg once daily for six months prevents oesophagitis relapse in up to 81 and 93% of patients, respectively, with comparable percentages of patients remaining in remission after 1 year of treatment. These high rates of remission have also been observed in studies of patients with lesions that were difficult to heal at baseline (resistant to healing with at least 3 months of H(2) antagonist
therapy). Moreover,
lansoprazole produces high remission rates regardless of the grade of erosive oesophagitis before acute healing. Among symptomatic patients with
heartburn,
lansoprazole provides rapid and effective relief of daytime and night-time
heartburn and prevents relapse of symptoms.
Lansoprazole has a wide margin of safety and is well tolerated when administered as monotherapy in short- and long-term clinical trials. Taken together these data suggest that
proton pump inhibitor therapy represents the preferred and ideal long-term management strategy for the patient with erosive oesophagitis.
Lansoprazole is a well-established member of this class of agents and, as such, has an extensive body of literature that supports its safety, tolerability and clinical efficacy in preventing relapse in these patients.