Comparison of omeprazole with ranitidine in the treatment of reflux oesophagitis

The amount and concentration of acid in the refluxed gastric contents are considered to be the major factors in the development and progression of reflux oesophagitis. Omeprazole, with its pronounced inhibition of gastric acid secretion, should therefore be a most effective drug for the treatment of patients with this disease. In an international clinical programme, the effects of treatment with placebo, ranitidine, 150 mg b.d. and omeprazole in doses ranging from 20 mg to 60 mg once daily, have been compared in patients with erosive and/or ulcerative oesophagitis. One placebo-controlled study and five comparative studies with ranitidine have been performed. Similar inclusion criteria, definition of oesophagitis on endoscopic evidence of mucosal defects, and assessment of symptoms were used in all the trials. It is evident from the placebo-controlled study that spontaneous healing of erosions and/or ulcers in the oesophageal mucosa seldom occurs. After 4 weeks of treatment, 6% (2/32) of patients randomized to the placebo group had healed, compared to 81% (25/31) treated with omeprazole, 20 mg or 40 mg once daily. In the five studies comparing omeprazole and ranitidine, nearly twice as many patients healed in the omeprazole-treated groups compared with those receiving ranitidine. The overall healing rate was 76% after 4 weeks on omeprazole (range 67-85%) and 37% on ranitidine (range 28-45%), and after 8 weeks the corresponding figures were 90% (85-95%) and 56% (43-66%), respectively. Apart from choice of treatment, only severity of the oesophagitis influenced the rate of healing.(ABSTRACT TRUNCATED AT 250 WORDS)