Gastroesophageal reflux disease. Acute and maintenance treatments with cimetidine

The comparative efficacy of a 12-week acute treatment with 800 and 1600 mg cimetidine daily and the effectiveness of a 400-mg single-dose maintenance treatment versus placebo lasting 6 months were studied in a double-blind fashion in 30 and 24 patients, respectively, with gastroesophageal reflux (GER) disease. Cimetidine in a dose of 800 or 1600 mg daily resulted in a significant symptomatic improvement and a decrease in the extent of endoscopic esophagitis. An improvement in the gastroesophageal sphincter function during treatment was suggested by a significant decrease in the frequency of reflux, as evaluated by isotope scintigraphy. No significant differences were found between the two doses of cimetidine. The overall initial improvement tended to be maintained during maintenance treatment, but no significant differences were found between cimetidine and placebo. The present study thus supports the use of 800 mg of cimetidine daily for short-term treatment of GER disease but provides no support for maintenance treatment with a low dose. The study further suggests that cimetidine treatment, by reducing the tendency to GER, may induce long-lasting remission of the disease.