Medline ® Abstracts for References 1-4
of 'Overview and comparison of the proton pump inhibitors for the treatment of acid-related disorders'
Acid suppression: optimizing therapy for gastroduodenal ulcer healing, gastroesophageal reflux disease, and stress-related erosive syndrome.
Wolfe MM, Sachs G
Gastroenterology. 2000;118(2 Suppl 1):S9.
Section of Gastroenterology, Boston University School of Medicine and Boston Medical Center, Massachusetts 02118-2393, USA. email@example.com
Asthma and gastroesophageal reflux: acid suppressive therapy improves asthma outcome.
Harding SM, Richter JE, Guzzo MR, Schan CA, Alexander RW, Bradley LA
Am J Med. 1996;100(4):395.
PURPOSE: To determine (1) the appropriate omeprazole (Prilosec) dose required for adequate acid suppression in asthmatics with gastroesophageal reflux, (2) whether aggressive acid suppressive therapy of gastroesophageal reflux improves asthma outcome in asthmatics with gastroesophageal reflux, (3) the time course of asthma improvement, and (4) demographic, esophageal, or pulmonary predictors of a positive asthma response to antireflux therapy.
PATIENTS AND METHODS: Thirty nonsmoking adult asthmatics with gastroesophageal reflux (asthma defined by American Thoracic Society criteria and reflux defined by symptoms and abnormal 24-hour esophageal pH testing) were recruited from the outpatient clinics of a 900-bed university hospital. Patients underwent baseline studies including a demographic questionnaire, esophageal manometry, dual-probe 24-hour esophageal pH test, barium esophogram, and pulmonary spirometry. During the 4-week pretherapy phase, patients recorded reflux and asthma symptom scores and peak expiratory flow rates (PEFs) upon awakening, 1 hour after dinner, and at bedtime. Patients began 20 mg/d omeprazole, and the dose was titrated until acid suppression was documented by 24-hour pH test. Patients remained on this acid suppressive dose for 3months. Responders were identified by a priori definitions: asthma symptom reduction by>20% and/or PEF increase by>20%. Asthma symptom scores, PEF's baseline and posttherapy pulmonary spirometry were analyzed.
RESULTS: Twenty-two (73%) patients were asthma symptom and /or PEF responders: 20 (67%) were asthma symptom responders, and 6 (20%) were PEF responders. Responders reduced their asthma symptoms by 57% (P<0.001), improved their morning and night PEFs by 8% and 9% (both P<0.005), and had improvement in forced expiratory volume at 1 second (P<0.02), mean forced expiratory flow during the middle half (25% to 75%) of the forced vital capacity (P<0.04), and peak expiratory flow (P<0.01) with acid suppressive therapy. Mean acid suppressive dose of omeprazole was 27 mg/d (+/-2.2) with 27% (8) patients requiring more than 20 mg/d. The presence of regurgitation or excessive proximal esophageal reflux predicted asthma response with 100% sensitivity, 100% negative predictive value, specificity of 44% and a positive predictive value of 79%.
CONCLUSIONS: Acid suppressive therapy with omeprazole improves asthma symptoms and/or PEFs by>20% and improves pulmonary function in 73% of asthmatics with gastroesophageal reflux after 3 months of acid suppressive therapy. Many asthmatics (27%) required>20 mg/d of omeprazole to suppress acid. The presence of regurgitation and/or excessive proximal esophageal reflux predicts a positive asthma outcome.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Alabama, Birmingham, 35294, USA.
Empiric trial of high-dose omeprazole in patients with posterior laryngitis: a prospective study.
Wo JM, Grist WJ, Gussack G, Delgaudio JM, Waring JP
Am J Gastroenterol. 1997;92(12):2160.
UNLABELLED: The optimal management of patients suspected with gastroesophageal reflux-related posterior laryngitis is unclear. History, physical examination, and ambulatory pH monitoring all have significant limitations in identifying patients who will respond to antireflux therapy.
OBJECTIVE: To evaluate the merit of empiric omeprazole therapy in patients with posterior laryngitis.
METHODS: Twenty-two patients (11 men/11 women, median age 58 yr) with newly diagnosed posterior laryngitis were enrolled. All had persistent laryngeal symptoms for at least 1 month. An empiric trial of omeprazole at 40 mg q.h.s. was given for 8 wk. Four laryngeal symptoms (hoarseness, throat burning/pain, throat clearing, and cough) and four esophageal symptoms (heartburn, regurgitation, dysphagia, and odynophagia) were scored from 0 to 3. Symptom scores were obtained before, 4 wk after, and 8 wk after the start of omeprazole. Patients were classified as responders if they were symptom free or satisfied with results. Omeprazole was stopped in the responders to look for relapse. Ambulatory pH monitoring was performed in patients who did not respond.
RESULTS: One patient discontinued omeprazole and withdrew from the study. In the remaining 21 patients, the total laryngeal and esophageal symptom scores significantly improved after empiric omeprazole. Fourteen patients (67%) were classified as responders. Eight patients (38%) had a relapse when omeprazole was stopped. Six patients (29%), interestingly, did not relapse and did not require long-term antireflux therapy. Seven patients (33%) were classified as nonresponders. Ambulatory pH monitoring was abnormal in four of the five patients who agreed to have this test. Increasing the dose of omeprazole to 40 mg b.i.d. provided no additional benefit in the nonresponders.
CONCLUSIONS: Empiric omeprazole therapy is a reasonable, initial approach to patients with suspected gastroesophageal reflux-related posterior laryngitis. A significant number of patients do well with a short course of antireflux therapy. Additionally, a third of the patients may not completely respond to intensive medical therapy despite the fact that reflux is documented.
Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
The clinical and economic value of a short course of omeprazole in patients with noncardiac chest pain.
Fass R, Fennerty MB, Ofman JJ, Gralnek IM, Johnson C, Camargo E, Sampliner RE
BACKGROUND&AIMS: Evaluation of new patients with noncardiac chest pain (NCCP) may require a variety of costly tests. The aim of this study was to evaluate the efficacy of the omeprazole test (OT) in diagnosing gastroesophageal reflux (GERD) in patients with NCCP and estimate the potential cost savings of this strategy compared with conventional diagnostic evaluations.
METHODS: Thirty-nine patients referred by cardiologists were enrolled. Baseline symptoms were recorded, and the patients were randomized to either placebo or omeprazole (40 mg AM and 20 mg PM) groups for 7 days. Patients were crossed over to the other arm after a washout period and repeat baseline symptom assessment. All patients underwent 24-hour esophageal pH monitoring and upper endoscopy before randomization.
RESULTS: Thirty-seven patients (94.9%) completed the study. Twenty-three (62.2%) were classified as GERD positive and 14 as GERD negative. Eighteen (78%) GERD-positive patients and 2 (14%) GERD-negative patients had a positive OT (P<0.01), yielding a sensitivity of 78.3% (95% confidence interval, 61.4-95.1) and specificity of 85.7% (95% confidence interval, 67.4-100). Economic analysis showed that the OT saves $573 per average patient evaluated and results in a 59% reduction in the number of diagnostic procedures.
CONCLUSIONS: The OT is sensitive and specific for diagnosing GERD in patients with NCCP. This strategy results in significant cost savings and decreased use of diagnostic tests.
Department of Medicine, Tucson VA Medical Center, Arizona, USA.