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The role and limitations of H 2 ‐receptor antagonist in the treatment of gastro‐oesophageal refrux disease
Author(s) -
COLINJONES D. G.
Publication year - 1995
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.1995.tb00778.x
Subject(s) - medicine , gerd , gastroenterology , gastric acid , proton pump inhibitor , omeprazole , gastro , reflux , antagonist , disease , esophagitis , histamine , secretion , stomach , receptor
SUMMARY Gastro‐oesophageal reflux disease (GERD) occurs in up to 44% of adults in the USA. Most individuals do not seek medical help, self‐medicating with antacids. Manifestations of GERD range from symptoms without oesophagitis, which constitute the bulk of patients who self‐medicate, to active oesophagitis and then to complications such as stricture and ulceration. It is the more severe cases who tend to come to the gastroenterologist, but it must be remembered that reflux symptoms are probably around 5–10 times more common than actual oesophagitis. Since acid in the refluxate is responsible for the bulk of the symptoms and mucosal damage, antacids are often used for quick relief—which of course may not be sustained. More prolonged suppression of acid secretion, such as by a histamine H 2 ‐receptor antagonist (H 2 RA) or a proton pump inhibitor (PPI), is required to give long‐lasting symptomatic relief and heal any inflammatory change. H 2 ‐receptor antagonists inhibit acid secretion with an effect that lasts for 4–8 h with a single dose, decreasing stimulated acid secretion by around 70%. When treating oesophagitis, the H 2 RAs suffer from the disadvantage of their relatively short duration of action (compared with PPIs), development of tolerance, and incomplete inhibition of acid secretion in response to a meal. Therefore, it is not easy for the H 2 RAs to achieve optimum conditions for healing the more severe forms of oesophagitis—even very high doses may fail. In mild GERD the H 2 RAs have been shown to be effective in relieving symptoms. In particular, when there is no oesophagitis, relief of reflux symptoms has been obtained after 4 weeks in almost all cases with a twice daily regimen: and it would seem that the sensitivity of the oesophageal mucosa may be reduced so that symptomatic remission is often obtained for a prolonged period after stopping therapy. In the milder forms of oesophagitis (grades I or II) healing can be achieved with all the H 2 RAs in 40–60% of cases in 8 weeks. This can be increased, by a substantial increase in dosage, to around 50–70%, but seldom higher than that. This higher dose has cost and compliance considerations. Proton pump inhibitors are required for higher percentage healing and especially for more severe disease.