Pantoprazole superior to ranitidine in preventing reflux esophagitis relapse


WESTPORT, CT (Reuters Health) – Long-term treatment with pantoprazole, a proton pump inhibitor, is more effective than ranitidine in preventing relapse of reflux esophagitis, regardless of Helicobacter pylori status, according to a report in the July issue of the European Journal of Gastroenterology and Hepatology.

Whether Helicobacter pylori status influences the effectiveness of proton pump inhibitor treatment and whether long-term treatment with such drugs prevents recurrent esophagitis remain controversial, the authors explain.

To resolve these controversies, Dr. Romuald J. Adamek, from St. Vinzenz Krankenhaus, in Dusseldorf, Germany, and colleagues compared pantoprazole with ranitidine in a 1-year study of 303 patients with stage II or III reflux esophagitis. For the first time, they also took into account the influence of the initial H. pylori status on the results.

By day 365, the cumulative proportion of patients with endoscopically proven recurrence of reflux esophagitis was 34.0% in the pantoprazole group and 66.0% in the ranitidine group (p = 0.0001), the authors report.

Similarly, 27.2% of pantoprazole-treated patients and 44.8% of ranitidine-treated patients experienced symptomatic recurrence of reflux esophagitis during the year (p = 0.0003), the report indicates.

In the intent-to-treat analysis, 66.3% of the pantoprazole group and 34.0% of the ranitidine group experienced neither an endoscopically proven nor a symptomatic recurrence of their reflux esophagitis (p < 0.0001).

Patients in both groups who were initially H. pylori-positive and received eradication therapy experienced similar relapse rates to the other patients in their respective groups, the researchers note.

Adverse events were similar in both treated groups, but adverse events were more common in patients who received H. pylori eradication than in those who did not.

"Pantoprazole 20 mg was far more effective than ranitidine 150 mg in the long-term prevention of recurrence," the authors conclude. "Eradication therapy for H. pylori infection did not influence the success of long-term proton pump inhibitor treatment."

Eur J Gastroenterol Hepatol 2001;13:811-817.

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