The advent of
histamine H2 receptor antagonists (H2-RA) has allowed the treatment of
reflux esophagitis (RE) to be controlled over a relatively long term. The authors have experienced some cases resistant to H2-RA, but it was revealed that these cases can be successfully treated with
proton pump inhibitors. It has been suggested that esophagogastric dysmotility can lead to RE. RE has been treated for many years by using GI-prokinetic agents, which theoretically inhibit
acid reflux and improve esophageal
acid clearance. In order to compare the effects on
acid reflux of an H2-RA (
famotidine), a
proton pump inhibitor (
omeprazole) and a GI-prokinetic agent (
cisapride), we measured the 24-hour pH in the esophagus and stomach simultaneously, before and
after treatment in 17 patients with RE. It was found that the
proton pump inhibitor was the most effective
drug for inhibiting esophageal acidification, followed by
famotidine and then
cisapride. Furthermore, we found that
cisapride often actually exacerbated
acid reflux. The differences in inhibitory effects on acidification allowed us to draw conclusions regarding the treatment of RE. It was concluded that the stronger the inhibitory effect of a
drug on
acid secretion, the more useful it was in the treatment of RE. The GI-prokinetic
drug did not inhibit
acid reflux as much as we had expected.