Selection of patients for successful maintenance treatment of esophagitis with low-dose omeprazole: use of 24-hour gastric pH monitoring

Am J Gastroenterol. 2000 Feb;95(2):374-80. doi: 10.1111/j.1572-0241.2000.t01-1-01756.x.

Abstract

Objective: Treating patients with erosive esophagitis and maintaining remission in a cost-effective fashion is a desirable goal in clinical practice. There are no established criteria to identify patients with healed esophagitis who will subsequently remain in remission with low-dose omeprazole therapy. We investigated whether 24-h esophageal-gastric pH monitoring could provide criteria to select patients for low-dose omeprazole maintenance therapy.

Methods: Seventy consecutive symptomatic outpatients with grade 2-3 reflux esophagitis were prospectively investigated. They were treated with 20 mg/day omeprazole for 2 months. Those with healed esophagitis were given alternate-evening 20-mg omeprazole maintenance therapy for 6 months. Clinical evaluation, endoscopy, and 24-h esophageal-gastric pH were done at the end of each treatment period. Results of pH studies of patients in remission were compared with those with endoscopically documented relapse of esophagitis.

Results: In 63/70 patient (intention-to-treat, 90%; 95% confidence interval [CI], 83-97%) esophagitis was healed at 2 months. During the 6-month maintenance period esophagitis remain healed in 28 (G1) (40%; 95% CI, 29-52%), but recurred in 32 patients (G2). During healing with omeprazole 20 mg/day the 24-h gastric pH was below 4 for <10% of the time in 96% of the patients, who subsequently remained in long-term remission with low-dose maintenance therapy (G1), but not in any patient with recurrence of esophagitis (G2). The 10% threshold value has a specificity of 1.00 and sensitivity of 0.96.

Conclusions: The 24-h intragastric pH monitoring during 20 mg/day omeprazole therapy provides criteria by which to preselect patients with reflux esophagitis who will remain in remission with low-dose omeprazole therapy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Confidence Intervals
  • Enzyme Inhibitors / administration & dosage
  • Enzyme Inhibitors / therapeutic use*
  • Esophagitis, Peptic / drug therapy
  • Esophagitis, Peptic / prevention & control*
  • Esophagoscopy
  • Female
  • Follow-Up Studies
  • Humans
  • Hydrogen-Ion Concentration
  • Logistic Models
  • Male
  • Middle Aged
  • Monitoring, Ambulatory*
  • Omeprazole / administration & dosage
  • Omeprazole / therapeutic use*
  • Patient Selection*
  • Prospective Studies
  • Recurrence
  • Remission Induction
  • Sensitivity and Specificity
  • Stomach / physiopathology*
  • Treatment Outcome

Substances

  • Enzyme Inhibitors
  • Omeprazole