Selection of patients for successful maintenance treatment of esophagitis with low-dose omeprazole: use of 24-hour gastric pH monitoring
| Autor: | S D, Ladas, P S, Tassios, S A, Raptis |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male Patient Selection Remission Induction Stomach Monitoring Ambulatory Hydrogen-Ion Concentration Middle Aged Sensitivity and Specificity Logistic Models Treatment Outcome Recurrence Confidence Intervals Humans Female Esophagoscopy Prospective Studies Enzyme Inhibitors Esophagitis Peptic Omeprazole Aged Follow-Up Studies |
| Zdroj: | The American journal of gastroenterology. 95(2) |
| ISSN: | 0002-9270 |
| Popis: | 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.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.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 for10% 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.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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|