Treatment of reflux oesophagitis with H2-receptor antagonists

The important therapeutic value of H2-receptor antagonists for the treatment of patients with reflux oesophagitis has been demonstrated beyond doubt. A large number of patients have been treated with cimetidine or ranitidine in controlled as well as open short-term studies. Mild to moderately severe reflux oesophagitis heals effectively when H2-receptor antagonists are prescribed for a sufficient time period, preferentially 12 weeks. The more severe forms of oesophagitis, however, need more profound acid suppression, with potent H2-receptor antagonists, addition of prokinetic agents, or treatment with H+/K+ATP-ase antagonists. Omerpazole has proven to be of high efficacy, particularly in the management of severe reflux oesophagitis. Data on long-term treatment with H2-receptor antagonists, to prevent recurrences after healing, are not reassuring: long-term low-dose H2-receptor antagonist therapy is not effective, and trials should be undertaken with higher doses of H2-receptor antagonists, more potent antagonists, or with combinations of antagonists and prokinetics. In these studies, 24-h intraoesophageal and intragastric pH measurements should be incorporated, to detect more accurately time periods of nonsuppressed acid secretion. Such studies will undoubtedly better define the therapeutic place of the presently available and forthcoming H2-receptor antagonists.