Reflux esophagitis differs from
peptic ulcer disease in many respects. Whereas nighttime
acid inhibition alone achieves healing in approximately 80 to 90% of patients with
peptic ulcer, more profound
acid inhibition seems to be necessary in those with
GERD. Conventional dosing with H2-receptor antagonists has been successful in only about 50% of the patients with
reflux esophagitis. Strong, prolonged 24-hour inhibition of gastric acid secretion is probably the most important factor in the treatment of
reflux esophagitis.
Omeprazole, a substituted
benzimidazole, produces effective 24-hour inhibition on gastric acid secretion. In doses ranging from 20-60 mg once daily,
omeprazole has proved to be effective in the short-term treatment of
reflux esophagitis, even in patients resistant to treatment with H2-receptor antagonists. Healing of severe, resistant
reflux esophagitis therefore is no longer a clinical problem.
Reflux esophagitis is a chronic, relapsing condition that cannot be compared to
peptic ulcer disease in all aspects. In particular, long-term
therapy must be more aggressive than the standard minimum maintenance dose used in
peptic ulcer. Not only for healing, but also for prevention of recurrences, strong, prolonged inhibition of
acid secretion must be provided. Experience of more than 5 years of continuous treatment with
omeprazole, in doses adjusted to prevent recurrences, has demonstrated the high efficacy of this agent in the long-term management of reflux patients.
Omeprazole provided the long-standing, strong
acid inhibition that is so important in treating this condition. Long-term treatment with
omeprazole in patients with resistant reflux disease did induce an initial rise of serum
gastrin levels, two to four times the pre-entry value.(ABSTRACT TRUNCATED AT 250 WORDS)