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Pantoprazole suggested as first-line therapy for GERD

מתוך medicontext.co.il

WESTPORT, CT (Reuters Health) – Pantoprazole is superior to nizatidine in relieving heartburn in patients with gastroesophageal reflux disease (GERD) and is an appropriate first-line therapy, Canadian investigators report.

Dr. David Armstrong, of McMaster University Medical Centre in Hamilton, Ontario, and associates at 16 Canadian centers randomly assigned 111 patients to treatment with pantoprazole 40 mg once daily and 109 to nizatidine 150 mg b.i.d. All of the subjects were outpatients with a diagnosis of GERD.

After 28 days of treatment, 60.4% of patients taking pantoprazole experienced complete relief of heartburn symptoms, compared with 33.9% of those taking nizatidine (p < 0.0001), the collaborators report in October issue of The American Journal of Gastroenterology. Among the 67 patients randomized to pantoprazole who were diagnosed with erosive esophagitis at baseline, 52 exhibited healing. In the 58 erosive esophagitis patients taking nizatidine, 24 experienced healing.

The investigators observed no interaction between treatment and the presence or absence of Helicobacter pylori infection. The frequency and nature of adverse events were similar between groups.

"Initial proton pump treatment should be the favored approach for GERD patients, [whether or not] the patient has been investigated by upper endoscopy at the time of initiation of treatment," Dr. Armstrong's group recommends. They suggest that only those patients with atypical symptoms and those who fail to respond adequately to drug treatment should be considered for endoscopic examination.

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