Medical therapy of patients with reflux oesophagitis poorly responsive to H2-receptor antagonist therapy.

There is substantial clinical experience of omeprazole treatment in patients with reflux oesophagitis, who have an incomplete or failed response to profound and prolonged acid-inhibitory therapy with H2-receptor antagonists. In The Netherlands, most patients with reflux oesophagitis poorly responsive to high-dose H2-receptor antagonists were healed within 3 months of treatment with omeprazole, 40 mg once daily. Only a few patients (less than 10%) with complicated reflux oesophagitis needed a longer duration of treatment or a higher dose of omeprazole to achieve complete endoscopic healing. Follow-up for up to 6 years has shown that most of these patients could be maintained successfully on omeprazole, 20 mg daily. However, about one third of the patients relapsed after healing when the maintenance dose was introduced. Evaluation of these patients who relapsed has shown that they require a higher level of acid-secretory inhibition; a maintenance dose of omeprazole, 40 mg once daily, rehealed the oesophagitis within 3 months. Only a few patients had a second relapse, and these patients were rehealed by an increase of the omeprazole dose to 60 mg daily. Oesophageal pH monitoring in these patients has shown that there is continued pathological oesophageal acid exposure, predominantly during the night, suggesting that the duration of major action of omeprazole was insufficient for production of adequate elevation of intragastric pH during the night. Successful control of reflux disease in these patients was achieved by increasing omeprazole therapy to a regime and dosage that achieved elevation of intragastric pH above 4 throughout the 24-hour period.